Developing Professional Identity - Patch 1 (1000 words) (LO2-3)

This essay will consider my knowledge and understanding of two professions within

the health and social care context as I begin my career in the health service. I have

decided to look at the roles and perceptions of midwifery and health visiting as they

are inevitably linked and would provide an excellent example of how effective inter-

professional collaboration can be achieved and work well. I will reflect on how my

views have been formed, considering the influence of media, personal experience and

family views and also how my views have changed since entering university and

commencing my training in midwifery.

The roles and history of the midwife and health visitor are inextricably linked.

According to the National Health Service (NHS), (2010) website (careers section)

the role of the midwife is to prepare women for the arrival of their baby, making

them a vital part in all stages of pregnancy, labour and the early postnatal period.

Midwives work within the community or in hospitals, providing antenatal/postnatal

care, counselling, support, education, and preparation for parenthood. Midwives may

specialise perinatal care, consultant midwife (providing clinical leadership across

maternity services), research, teaching, practice development, management within a

Trust, influencing healthcare across a whole community, neonatal nursing and health

visiting. Health visitors are either nurses or midwives with the Community Health

Service, whose main focus is in prevention i.e., helping people to stay healthy and

avoid illness. They have specialist qualifications in child health, health promotion and

health education. They work particularly with families with children under five and

the elderly and because they are attached to GP practices look at the broader

picture to identify that the health needs of the community, allowing them to affect

local policy (NHS, 2010). In effect, they take over where the community midwife's

role ends, and often work alongside midwives in pre-birth classes, breastfeeding,

postnatal depression and parent support. However, they will have a wider concern

with the circumstances in which a young child is growing up, tailoring health plans to
the needs of the family. Both midwives and health visitors are educated at degree

level and are regulated by the Nursing and Midwifery Council (NMC), (2009).

My views of both midwives and health visitors have been formed, primarily from

experience and secondary from a wish to be a nurse when I left school. You had to

become a nurse first as direct entry was uncommon, lectures were formal with a

midwife and obstetrician and clinical teaching took place on the wards with real

women as models. Antenatal clinics were noisy and crowded due to larger families and

mothers having to bring along all of her children. Antenatal care was sporadic where

the midwife booked you in; vouchers for orange juice and cod-liver oil and milk issued

and offered very little by way of support and information, subsequent visits were few

and far between. Labour was extremely medicalised and home births occurred when

you couldn’t get to the hospital in time. Postnatally, women stayed in bed for a few

days and perineal wounds swabbed daily. Babies were cared for in the nursery and

brought to mothers at regular feeding times depending on their birth weight, three

hourly for small babies and four hourly for larger babies with some supplementary

feeding occurring if the mother had problems breastfeeding, which would not go

down very well in today’s maternity units[ CITATION Kar09 \l 2057 ]. Likewise, health

visitors were either judgemental, authoritarian figures, usually near retirement

spinsters, who would order you about or they would be supportive, calm, empathetic

but bracing, informative and reassuring and nearly always available by phone, this

would not be so today. Health visitors would take over from the midwife, run regular

clinics to weigh and immunise babies, completed vision and hearing checks and

generally monitored the health and wellbeing of the baby/child [ CITATION Hil08 \l 2057 ].

They could detect postnatal depression early leading to timely treatment and

prevention of serious consequences for the whole family. Health visitors could

reassure and take care of minor problems, alert the team to an at-risk child and

saving GP’s time and money for the NHS where resources are often wasted [ CITATION

Hil08 \l 2057 ]. I had thought that after a 24 year gap between pregnancies things would

have changed, however, sadly, this is not always the case and both midwives and
health visitors are still viewed as symbols of the ‘establishment’ and dubbed intrusive,

nosy or prying (Mounce, 2004).

This perception is only exacerbated by the media with shows like Casualty and Holby

City (BBC, 2010) and any number of soaps who misrepresent the roles of both the

midwife and health visitor. The media’s sensationalism of high profile cases such as

Victoria Climbie and Baby P, only seem to focus on the bad things about the health

care system and the professions working within them. Then there are the ‘horror’

stories from friends and family, all depicting the authoritarian figure who tells you

what to do and when to do it without empathy or understanding. The King’s Fund

suggests that the way health risks are reported may alert people/governments to

genuine risks prompting appropriate action. However, news media coverage may

encourage behavioural change not in the public’s best interests or may prevent the

adoption of healthier lifestyles. It may also deter authorities taking proactive

measures to protect health and lead to policy changes with unforeseen negative

consequences (Harrabin R, Coote A, Allen J, 2003). For example, contraception pill

fears reported in 1983 led to a 14% drop in pill prescriptions and a rise in abortion

rates in 1984 (Welling K, Kane R, 1999).

The question of how my views have changed since commencing my training is difficult

to answer, parents are concerned about access and confused about what to expect

from the midwife and health visitor alike. Parents, commissioners, GPs, local

authorities, policy makers and the profession all seem to have different expectations

of the role of both midwife and health visitor and what services should be provided

and as a group midwives and health visitors have an image of being authoritarian,

defensive and resistant to change [ CITATION Low07 \l 2057 ] . Having observed the

practices of midwives and briefly health visiting during my first placement, I have a

deep respect for the work that both midwives and health visitors do. They are

tireless, working long hours often beyond long shifts; they rarely take breaks due to

the heavy workload and always put women and their families first. Of course there

are always a very few ‘apples in the barrel’ who are flawed and inevitably let the
health profession down rather spectacularly if the media had its way. This

experience has already changed my limited views as a layperson with only one side of

the story and seeing the difficulties involved in putting in place care that is person

centred, that the client’s dignity is maintained and that confidentiality is respected

and communication established and maintained. I also fully expect to change my views

of the health care professions again as I progress through my training.

Service User Voice - Patch 2 (500 words) (LO2 - 3)

It should be acknowledged that although I am training to be a midwife within the

health and social care field, I am still and always will be, in a position of service user

accessing the health and social care services. For instance I recently underwent an

endoscopy procedure at an NHS Treatment Centre on referral from my GP to confirm

his diagnosis of hiatus hernia. I had already researched my symptoms from various

sources including the NHS Choices website and therefore was familiar with my GP’s

diagnosis and what options were available. The treatment centre sent me some pre-

procedure literature and a health questionnaire which had a section for any questions

that I may have concerning any aspect of the forthcoming procedure. However, even

though I had all this information and am reasonably intelligent, I was still

apprehensive, I had never undergone any procedure where I may need to have a

sedative or general anaesthetic and I had heard several first-hand stories about this

procedure. I had been given a sedative before which had no effect on me whatsoever

and I contacted the Treatment Centre to say that I would prefer a general

anaesthetic to a sedative as I knew that the sedative would have no effect. I was

very disappointed at the condescending way in which the nurse told me that really a

sedative would be more than enough and that they did not use general anaesthetic in

such cases. I felt that I had not been heard, that my concerns had not been

addressed and I had been brow-beaten into accepting what the health service wanted

me to do instead of what was best for me. Client-centred care seemed to have been

pushed aside in order to save perceived costs.

My fears were borne out in that even though I was given a double dose of sedative I

was still groggily aware of what was happening and apparently pulled the apparatus

out four times until the consultant called a halt and stated that I should have had the

procedure under general anaesthetic in the first place and was annoyed that I had

got that far as I had quite clearly informed the staff on the questionnaire and

verbally that I would have preferred the general anaesthetic and the reasons behind

my request. The procedure had to be re-scheduled with an anaesthetist for general

anaesthetic, which they did in fact provide despite being informed by the nurse that

this was not used. I had a burning urge to say ‘I told you so’, but I was struck by the

fact that since I had had to have two procedures when one should have sufficed, the

cost of the procedure had doubled due to the attitude of one person who was not

prepared to listen, acknowledge that I was not simply irrational but had sound

knowledge of myself and my body’s reactions. It would also be safe to say, that in my

opinion, NHS management’s attempts to save costs could possibly increase them in

instances such as these. Communication or lack of it played a major part in

determining a plan of care that could easily have been different and I felt that the

money wasted on me could have been better put to use elsewhere and that

accountability was also not dealt with satisfactorily.

Foundations of Professional Collaboration - Patch 3 (1000 words)(LO2 – 3)

As I have progressed and developed through my professional healthcare programme

in midwifery my views of the professional’s role have altered dramatically and this

can be demonstrated briefly in a recent study which explored the beliefs of college

students about childbirth and midwifery (Bernicki Deloy, 2010). The findings of this

study present a great challenge to midwifery advocates as childbirth was perceived

as a dangerous medical condition, that medical technological interventions were a

necessity and that there was a great deal of doubt about the training and practice of

qualified midwives. Although this study was undertaken in America, these

perceptions can easily translate to the UK and raise the big question of how to

educate consumers about the quality of midwifery care when extensive cultural
discourses benefit the medical representation of childbirth. Portrayals of midwives

in the popular media were also analysed, and Kline (2003) found that television shows

lessen the midwifery model of care while pleasing the medical model, and concluded

that ‘‘fictionalized accounts of important social issues can influence the ways people

make sense of and make choices with regard to their health.’’ Apart from the factual

evidence they found in online resources or books, contributors to the study

advantaged the personal experience of families, friends, and even strangers on the

internet when assessing midwifery care which may mean that storytelling may be an

important complement to scientific evidence when educating women and their families

about their options for maternity care providers. Working with midwives and other

healthcare professionals has shown me that being a professional is not as easy as it

sounds and that it will take more than just saying the right words (Bernicki Deloy,

2010). The disposition of health and social care is, for many, the quality of the

service received is reliant on how effectively various professionals work together.

Progress in knowledge and originality in approaches to the delivery of healthcare

services; have brought about a high level of specialisation (Barrett, Sellman &

Thomas, 2005). This signifies that it is not always possible for any one professional

to have adequate knowledge and skills to respond to the needs of individuals, groups

and communities in situations of complex requirements (Irvine, Kerridge, McPhee &

Freeman, 2002). Professionals, therefore have a moral obligation to work inter-

professionally, in order to best serve the interests of the service user (Barrett,

Sellman & Thomas, 2005).

Communication is important in its own right as it transgresses all aspects of

healthcare. Effective communication can be hard to achieve and sometimes it

appears that no matter how circumspectly we phrase what we want to say, the

listener still does not understand or misunderstands what we are trying to convey

(Deane-Grey, 2008). Furber & Thomson, (2010) suggest that language can be used to

undermine women, whist others state that language influences power differentials

during social interactions (Shirley & Mander, 1996). In maternity services, language is
sometimes used to control (Hastie, 2005), and involves power and access to choices

(Shirley & Mander, 1996). Language communicates beliefs (Reibel, 2004); therefore,

information provided by authority figures, i.e., midwives, may ‘trigger’ an idea when

spoken confidently to pregnant mothers (Hastie, 2005). Language needs careful

consideration in order to encourage an impartial perspective, enabling women to make

informed decisions (Laverack, 2005). Women should expect and receive information

in a non-prejudiced, non-judgemental manner, with the chance to consider options for

successful partnership working (DH, 2004). Ultimately, women want midwives to

listen to their needs (Redshaw et al., 2007). Dialogue should encourage two-way

communication and promote equal involvement to empower women to make their own

decisions (Laverack, 2005).

Koubel & Bungay (2008) indicate that self-awareness crucial for practitioners to be

able to practise in a person-centred manner and it is suggested that both verbal and

non-verbal communication skills are predisposed by both culturally entrenched

professional ‘norms’ and individual values, which consciously and unconsciously affect

our perceptions of others. To assist in increasing self-awareness the Johari window

model is offered to question the beliefs and perceptions of others and how these

affect care delivery. Koubel & Bungay (2008) also present the argument that and

person’s ‘moral intuition’ is not adequate to confront the challenges of day-to-day

health care. Practitioners need to have some knowledge of an ethical framework to

support their practice. Koubel & Bungay (2008) use ethical theories that have

educated health and social care practice, such as consequentialism, deotonology and

virtue ethics, and explores the development of human rights, reflecting on the

connection between the roles and responsibilities of care professionals and the rights

of the consumer.

As health requirements become more complex, so does influencing, leading and co-

ordinating women-centred services. Poor partnerships, referral and handovers

between health care professionals/organisations increasingly affect the safety and

quality of care. The effect is that women are not being offered choices; whilst
others, with more complicated requirements, do not receive all the additional care

they should have[ CITATION Dep09 \l 2057 ]. In practical terms, this principally affects

underprivileged/vulnerable women, who fall through disparity in services, leading to

poorer outcomes. Midwives are in a good position to merge the roles of primary carer

and care guide through the maternity care pathway, thereby improving women’s

experiences with services; and enabling improved detection and timely treatment of

women/babies with complications, leading to long-term health gains. Increasing

professional collaboration and continuity of care for healthcare are improved when

working closely as part of a multi-disciplinary team, referring women, according to

individual need, to medical/social care professionals. The quality of midwifery care

is measured by the experiences of the women using healthcare services and the

clinical consequences for woman and baby. A high quality health care service should

demonstrate understanding and meet the requirements and expectations of clients by

offering the best possible person-centred care and high standards of clinical safety

[ CITATION Dep09 \l 2057 ]. .

Midwifery education should reflect the demands and challenges of women-centred

care needs and education commissioners/employers must develop collaborative

partnerships with universities/training organisations to determine what needs to be

taught, how it needs to be taught; and who is offering the teaching, when and where.

The educational evidence base is the most useful method of academic and clinical

education needs to introduce methods which have the best outcomes for clinical

practice and productive assessments of student practice could also include reviews of

care by the client. Midwife mentors should be confident in supporting women in

‘normal’ birth, such as a home birth; or in the use of water in labour and birth

[ CITATION Dep09 \l 2057 ].

Developing relationships with other student healthcare professionals within the

health and social programme has assisted in my understanding of the roles of my

fellow health professionals and is likely to play a large part in how I treat my clients

and their families throughout my training and consequent career. Younger (2010),
claims that debates/discussions in lectures enables students from multiple disciplines

to gain valuable insight into how similar conditions/situations may be managed from

different viewpoints. I myself, feel I have developed a better understanding of the

importance of effective communication and common respect between various health

care disciplines and believe that teamwork is the most valuable way of ensuring

holistic care for all women. As a midwife, person-centred care involves every aspect

of a woman’s wellbeing and seeking assistance from those with relevant knowledge and

skills is essential. Through sharing ideas, experiences and reflections with other

health care students I am able to form a deeper understanding of the pressures and

challenges, other health care professional face on a day-to-day basis. I am looking

forward to continuing my inter-professional learning right the way through my degree

and career and will not undervalue the importance of professional collaborative

practice.

(2566 words)

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