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Making a Change

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Introduction

An Bord Aitranais is the legal body responsible for the regulation of the practice of midwifery and nursing in Ireland (Anderson et al. 2008). The main role of the board is the provision of training, education, and professional conduct among nurses and midwifes (Begley 2010). These regulations and guidelines aim at protecting the public through advocating for high standards, which covers education, training, and professional conduct of midwifes (Hayes et al. 2011).

A midwife is a professional who, having been regularly admitted to a midwifery training programme duly recognized in Ireland by the relevant committee, has successfully finished the prescribed course of studies and has acquired the skills and qualifications to be registered or legally licensed to practice midwifery (Jacobs et al. 2008). A midwife is an individual able to give relevant care and advice to women during pregnancy (ABA 2010).

These activities continue during pregnancy, labour and the postpartum period. The care includes detection of abnormal conditions in mother and child. It also includes preventive measures and carrying out of emergency procedures in case of absence of medical help (Clawson et al. 1993). A midwife has a special task in health counselling and education; this is limitation to women only, but the whole community may also benefit from such services (ABA 2000).

These professionals are responsible for antenatal education and preparation for parenthood; such services include gynaecology, family planning, and child care. The law allows midwifes to practice in clinics, hospitals, health units or any other areas acceptable to them (Davidson 2009).

An Bord Aitranais has come up with values which should underline midwifery practice and provide the basis for the formulation of a philosophy of midwifery (Pearce et al. 2011). Midwifes should take a pregnancy as part of the life cycle, which is a healthy, normal event filled with personal meaning for each woman, family and child (Spurgen et al. 2007). The focus of midwifery practice is to provide women-centred care from pre-conception through to the postpartum period (Wall 2003).

Midwifery practice is holistic in approach and recognizes the dignity and diversity of each woman irrespective of her emotional, social, spiritual, and cultural needs. The concept of the corporation between the female patient and the midwife is vital to the midwifery profession (Anderson et al. 2008). It bases on mutual trust, collaboration, and support, which facilitates evidence based decision making. The midwife has to respect a woman as the primary decision maker; the midwife should assist her in the process of decision making (Wall 2003).

Decisions regarding an individual midwife’s level of practice should be made with the interests of babies and women at the heart. Midwifery practice bases on the best available evidence, which enhances the maintenance of quality standards of maternity care for women and their babies (Davidson 2009).

The above explained roles are highly vital for anybody who wishes to take midwifery as a career; newly qualified midwifes are of the opinion that numerous changes have to be put in place in order to ensure that women and community at large enjoy better services from the members of the midwifery society (ABA 2010). The current state of affairs is that the paediatricians are to examine and discharge the delivered babies in the hospitals (Jacobs 2008).

This is a central change that the newly qualified midwives would like to be in operation; this will mean that midwifes will have additional roles to play in their professional lives. The newly qualified midwives have observed a number of issues that they have observed in most of the clinics, hospitals and even health units across Ireland. These issues have prompted one as a midwifery professional to come up with various suggestions, which if well formulated and implemented by the board can lead to increase in quality delivery and proper utilization of skills of professional midwifes in Ireland.

Clinical Governance Framework

Clinical governance is a framework or mechanism through which healthcare organizations like clinics, hospitals, and health units are responsible and accountable for enhancing the quality of their services and ensuring high standards of care by creating an enabling environment in which success in clinical care will increase (Pearce et al. 2011).

It encompasses all the individual processes needed to achieve the highest quality practice with regard to the available resources; the resources range from both the human and non-human factors that play various roles in midwifery (Hayes 2011).

According to Anderson et al. (2008), clinical governance integrates all the activities that affect the patient or client care, a collective term for all that helps to improve and maintain the quality of care. The governance has a number of key themes that are crucial for its success. The midwife should place the patient’s experience at the heart of health care and make information work for the system and the individual practitioner and patient. The practitioner should consider quality improvement, support staff in the workplace and build blocks of clinical governance.

Clinical governance framework aims at modernizing and strengthening professional self-regulation. The framework is to improve existing systems for quality control based on clinical standards, evidence based standards and learn from the lessons of poor performance (Chambers et al. 2000). The framework is to ensure that good practice identification and the building get prioritization (Wall 2003).

According to the department of Health, clinical governance is a framework through which NHS organizations are accountableand responsible for improving the quality of their services and ensuring high quality healthcare by creating an environment in which success in clinical work will flourish (Clawson et al. 1999). Midwives’ requirement is to attain ‘recognizably high standards of care’ by use of available evidence in their practice (Begley 2010).

It follows that the newly qualified midwives have to learn continuously and gain more knowledge in order to get ‘transparent responsibility and accountability for those standards’ by being able to provide rationales supporting my practice (Davidson 2009). Newly qualified midwives are aware that continuous development through changes of the health system is a requirement to ensure “constant dynamic improvement”.

As the newly qualified midwives, they have a lot to offer to the midwifery. They believe that availability of the best Clinical governance is extremely vital in ensuring safety for the mother and continuous improving of care through clinical risk management, clinical audit, and practice development (Jacobs 2008). Outlines that proper clinical governance will ensure responsibility and accountability among the stakeholders.

For that to be realized, measures to address contemporary issues like changes in culture, behaviour, teamwork and ways of thinking are to be in place. The newly qualified midwives will practice the expertise they attain from the midwifery school in various ways. They have the opportunity of interacting with highly skilled professionals and lecturers who have taught them in various ways. This will ensure that they play a vital role when it comes to clinical governance framework formulation, implementation and monitoring.

Evidence-Based Practice

According to ABA (2010), it will be highly critical for every newly qualified midwife to make use of evidence-based practice throughout my professional life. The main task ahead of a newly qualified midwife will be to identify what constitutes ‘evidence-based practice’. According to Wall (2003), it is extremely easy to find research to support almost all clinical claims and practices. He observes that it is usually good to evaluate and criticize any research findings to weigh the legitimacy of the claims.

As the newly qualified midwives, they will always provide strongest evidence for a treatment or intervention to address clinical aspects that are ahead of them. They shall examine both the methodology along with the potential limitations and biases before accepting the results of any study (McDonald, 2013).

They will take a holistic approach when implementing evidence-based care; this shall help them to address many factors relating to both effectiveness and safety of potential options. They will have to put into consideration issues like values and wishes of those receiving care in order to serve them with a touch of professionalism and ethics (Wall, 2003).

According to ABA (2010), newly qualified midwives will have to conduct a lot of research activities in order to come up with findings that shall inform their future undertakings as midwives. These research activities shall be available for evaluation and criticism by other professional members that they shall be working with.

Multidisciplinary Meetings

Southern Health and Social Care Trust are the first midwifery care units in Ireland. These two institutions and many others are able to offer women more choices during their pregnancy and childbirth experiences by focusing on multidisciplinary meeting (Spurgen et al. 2007). Communication tools emerge from such units, which lead to professional handling of prenatal and postnatal activities.

According to Practise Standards for midwives (2010), newly qualified midwives will fully participate in clinical meetings and discussions between disciplines with regard to supplementary supervision of the mother and her unborn child. Such measures shall mean that the newly qualified midwives will be capable to work in a conducive and professional environment (McDonald 2013).

Clinical Audits

Clinical audit is a quality enhancement technique that seeks to improve healthcare and outcomes through systematic evaluation of care against explicit criteria and the formulation of change (Anderson et al. 2008). To achieve the objective of enhancing change as newly qualified midwives in Ireland, they will urge the management a medical centre where they will receive mandate to review the performance of activities to ensure that everything is running.

According to An Bord Altanais, newly qualified midwives will help in coming up with a framework to enable improvements in case of any deviations. This mechanism is already in practice, in Ireland, though its effectiveness is questionable and they will use that loophole to ensure framework change (ABA 2010).

There are four types of clinical audit, namely, standard-based audit, adverse occurrence screening and critical incident monitoring, peer review, and patient surveys and focus groups (Chambers et al. 2000). Newly qualified midwives will advocate for standards-based audit and peer review. Under standards-based audit, they will help in coming up with a cycle, which involves defining standards, collecting data, and implementing any changes deemed necessary (McDonald, 2013).

Under peer review, they will emphasis on valuation of the quality of attention provided by a clinical team with a view to improving health care. They will also advice the management to exploit the two remaining methods if the need arises since they may be critical in clinical governance (ABA, 2010).

Implementing a Change

The change that newly qualified midwives aspire is the government and other relevant stakeholders to initiate relevant legislation. The change will enable midwives perform the examination of the new born instead of the doctors. It is extremely difficult to challenge indigenous or traditional practice and change well-established patterns of care especially if the concerned environment is not suitable for change (Hayes 2011).

In Ireland, the An Bord Aitranais is responsible for setting the rules and guidelines within which nurses and midwifery operate. Therefore, it is difficult to alter the rules without a lot of legal and technical considerations (Clawson 1993). They have been students in one of the leading schools in Ireland and had the privilege of associating and learning from highly qualified and extremely experienced professionals and lecturers.

From the way, current midwives get their training; they do not see and appreciate the reason why doctors should continue examining the new born babies. They believe that being members of the newly qualified midwives has the ability and capability of handling examination technicalities of the newly born baby (McDonald, 2013).

According to Begley (2003), senior house officers have been discharging head-to-toe examination of new born for a very long period. However, the prevailing economic climate has led to politically driven reforms in policies that may or may not suit midwives and their duties, which means it is necessary for midwives to carry out deeper training in this field. 

Doctors demand huge sums of money, which the economy of Ireland is reluctant to pay. The government is encouraging comprehending education and training, which will make midwives able to conduct a full examination to newly born baby without necessarily requiring a doctor (Pearce et al. 2011).

ABA (2010) supports the idea of midwives taking over some of the roles played by medical doctors. It bases this argument on the economic and social point of view. On the economic front, the move is necessary since it limits the amount of doctors thus saving on cost; it also increases productivity of midwives by increasing their skills.

The government of Ireland through the Mid-Western Maternity Hospital together with  the National Institute for Clinical and Health Excellence have come up with mechanisms to support newly qualified midwifes to start carrying out examination by starting with relatively smaller roles like skin-to-skin contact (McDonald 2013).

This change is possible since the government of Ireland has many institutions with the capacities to train midwives across the country. The government is investing heavily in medical training and research, which can ensure that the new crop of midwives has the necessary skills to effect this changes (Jacobs 2008). The scarcity of doctors with respect to the number of women who need antenatal and postnatal care makes it possible to retrain the midwives to fill that void.

In the modern day midwifery, there is a constant requirement for change in attitudes and working practices. Customers are addressing these needs and want make it possible for the midwives to deserve the support make them able to retrain and examine babies and infants (Hayes 2011).

The other reason why newly qualified midwives think this is possible is because the midwives have the necessary management skills (Wall 2003). Midwives have transactional leadership skills, with their task centred and autocratic approach to staff management, which is necessary for the 21st clinical management. The proposal of letting midwives take over the whole process of examination is safe.

This is because the current crop of midwives is increasingly knowledgeable. The result is the ability to perform examination safely with a lot of professionalism. The current Legislations do not oppose the idea of change since various stakeholders, as well the government, are in support of this view due to the socio-economic dynamics involved (ABA, 2010).

According to McDonald (2013), midwives have to be empowered in order to accept the changes proposed by the newly qualified midwives, procedures have to be set to encourage practising midwives to accept new roles. An Bord Altanais has to set up regulations and guidelines of offering on the job training. This shall enable them to gain additional skills to carry out the whole examination process on the delivered babies. Seminars, trainings, and motivational mechanisms have to be put in place in order to urge the practising midwives to accept the new changes in their respective roles.

Empowerment shall entail salary, and other allowances increment to boost the morale of the midwives in Ireland. An Bord Altanais has to urge the Department of Health and the government to increase salaries of midwives to enable them to carryout additional tasks (McDonald 2013).

Conclusion

This paper analyses a possibility of there being a change where midwives are going to examine the delivered babies and infants on their own. This would be without requiring the services of senior medical members like doctors. The paper looks at this change from a recent dimension where relevant policies and mechanisms ensure adequate training and retraining of midwives. This is in order to impart on them skills that enable them undertake the whole examination process.

The paper covers many aspects to prove the need for this change. Their view is that, regarding skills that they have acquired in midwifery convince that the midwives are ready to take over the examination activities and provide better school and quality healthcare to the community (ABA, 2000). The change result is to entail systematic reforms and various plans which shall ensure that midwives goes through intensive training, which shall enable them to acquire skills to perform their new duties diligently.

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