A discussion on how the midwife demonstrates her professional accountability through effective communication, including an awareness of factors, which may contribute to poor communication.
The Nursing & Midwifery Council (2004a, p. 17) in addressing the responsibilities and sphere of practice for midwives under Rule number 6 of their “Midwives rules and standards” brings forth the importance of communication by stating that midwives “Should work in partnership with the woman and her family” and “Should enable the woman to make decisions about her care based upon her individual needs, by discussing matters fully with her”. Rule number 6 adds that the midwife also “Should respect the woman’s right to refuse any advice given” (Nursing & Midwifery Council, 2004a, p. 17). In furthering the roll of effective communication, Rule 7 under “Administration of medicines” as put forth by the Nursing & Midwifery Council (2004a, p. 19) advises that “A midwife must respect the right of individuals to self-administer substances of their choice”.
The preceding specifications have been brought forth as they help to set the foundational context for this examination, that seek to explore how the midwife demonstrates her professional accountability through effective communication, including an awareness of factors, which may contribute to poor communication.
The Nursing & Midwifery Council (2008a) under a document titled “The Code: Standards of conduct, performance and ethics for nurses and midwives” begins its document by stating that “The people in your care must be able to trust you with their health and well-being”, and that in order for nurses and midwives “To justify that thrust …” they need to be able to conduct effective communication in a broad sphere of activities and actions. In elaborating upon the foregoing “The Code” adds that midwives need to “be open and honest…” along with acting with integrity (Nursing & Midwifery Council, 2008a). The preceding means that they must and are accountable for their actions, means that accordingly that they must “… treat people as individuals …” respecting their dignity, as well as acting “… as an advocate for those in …” their care, aiding and assisting them in accessing “… relevant health and social care, information and support” (Nursing & Midwifery Council, 2008a). The importance of effective communication is further underscored in the dictates of “The Code” that states midwives must “Respect people’s confidentiality”, mandating that midwifes need to respect their patient’s “… right to confidentiality”, informing them as to the “… how and why information is shared …” among those providing for their care, and importantly, that midwifes “… must disclose information … (if they) … believe someone may be at risk of harm …” in accordance with the law (Nursing & Midwifery Council, 2008a).
The foregoing represents rules of ethics as well as conduct that provide the foundational understandings for the conduct of midwives. Importantly, the underpinning of the relationship between midwives and patients reside in collaboration. That communication means listening to their patients, along with responding “… to their concerns and preferences”, and the support of their patients “… in caring for themselves to improve and maintain their health” (Nursing & Midwifery Council, 2008a). The critical facet of effective and ongoing communication and trust resides in the trust between patients and midwives, as this is the foundation of care. That foundation includes the respect as well as recognition of “… the contribution that people make to their own care and well-being”, and sharing information, conversation and professional advice in a manner their patients can understand (Nursing & Midwifery Council, 2008a).
The preceding means the meeting of language as well as communication needs, along with gaining consent before beginning any treatment or care programs to ensure patients are absolutely clear on what such entails (Nursing & Midwifery Council, 2008a). The preceding means that the patient’s right to either accept or decline care and or treatment is inherent in their rights, along with their being fully informed as well as involved in decisions as such relate to their care and treatment (Nursing & Midwifery Council, 2008a).
Effective communication and accountability in the conduct of duties as a midwife includes their relationship with their supervisors as well as doctors, hospitals and other staff, organisations. The foregoing was detailed in another document from the Nursing & Midwifery Council (2007) titled “Standards for the supervised practice of midwives” whereby the important of communication and professional practice means that midwives need to maintain a communicative relationship with their supervisors and the aforementioned support staff to further their own development. In addition, midwifes need to be able to honestly evaluate their own performance to shore up areas that they are either weak or not proficient in (Nursing & Midwifery Council, 2007). Communication goes to the heart of delivering effective care, as the patient needs to develop an ongoing rapport, and advise the midwife of all facets connected with their care
‘Prep’ stands for ‘post-registration education and practice’ that represents standards as well as guidance in the providing of care and practice that maintains high levels (Nursing & Midwifery Council, 2008b). Under the preceding, nurses and midwives are required to record continuing professional development, in compliance with standards and practice (Nursing & Midwifery Council, 2008b). One provision under this requirement is that midwives, as well as nurses, are required to be able to demonstrate their “… ability to use appropriate communications, teaching and learning skills”. The importance of the preceding is that effective communication is stressed in every Nursing & Midwifery Council (2008) document. The significance of the preceding is detailed in the Nursing & Midwifery Council’s (2004b) document “Complaints about unfitness to practise: A guide for members of the public” that deals with allegations concerning care practice by midwives. This guide for patients indicates that issues concerning complaints encompasses “… verbal abuse …” “… failure to provide adequate care …” “… concealing unsafe practice …” as key areas, all of which can potentially have their roots in poor communication between midwives and patients. Such instances can be avoided through proper and ongoing communication with patients in a professional manner that emanates from the beginning of the relationship, on through every meeting and or communication exchange.
The scope of the preceding, communication, as an important facet in the professionalism and accountability of a midwife is contained in the Nursing & Midwifery Council’s (2004c) “Reporting lack of competence: A guide for employers and managers” that states that one of the characteristics the indicates and or demonstrates a lack of competence includes a “… difficulty in communicating with colleagues, patients or clients”, the “… inability to work as apart of a team …”, and “… poor judgement …” (Nursing & Midwifery Council, 2004c). In looking at the foregoing, one can see that communication is either at the heart of, or a symptom. Further importance, as well as administrative recognition of communication as a core foundational aspect in the practice of midwifery is contained in the Nursing & Midwifery Council’s (2004d) “Reporting unfitness to practise: A guide for employers and managers” that states that fitness to practise might be impaired by a “… persistent lack of ability in properly identifying care needs and accordingly planning and delivering appropriate care”.
Accountability and Communication
The critical nature of health care delivery entails listening and communicating with patients as an active and ongoing dialogue. The critical nature of effective communication as well as accountability and the ramifications of poor communication skills can be a result of the creation of a non-harmonious rapport with the patient that results in misunderstood communication concerning the methods of care and or options open to them, as well as a host of associated factors. In a document as prepared by the Nursing & Midwifery Council’s (2008c), listening to patient concerns regarding their care is the first of a list of areas that includes the creation of an “… environment that facilitates effective communication …”. The emphasis on communication is paramount in the health care profession (Ellingson, 2002).
In a study conducted Catherine McCabe (2004, pp. 41-49) she starts her report advising “Patient centred communication is a basic component … and facilitates the development of a positive nurse-patient relationship … (that) … results in the delivery of quality … care”. Her study uncovered that a lack of communication, along with empathy were two of the most cited reasons by patients in complaints about their health care delivery. The diversity that exists in the UK makes the subject of effective communication even more compelling. Language, educational, believe systems, unsureness and or suspicions regarding the role and or competence of midwifes, tales involving others negative experiences with midwives, as well as a host of other factors represent impediments to the profession that a midwife needs to be aware and cognizant of in establishing contact with a patient, and developing an atmosphere of trust and confidence (Devries et al, 2001).
In an article published by Medical News Today (2007), it stated that the NMC Code “… requires each nurse and midwife to act at all times in a such a manner as to justify public trust and confidence”. The article went on to add that “Nurses and midwifes are personally accountable for their practice …” stating that their professional accountability requires them to “… work in an open and co-operative manner with patients and their families …” recognising patient input and involvement in their care and health planning (Medical News Today, 2007). While the bulk of this study has focuses on the midwives communication with their patients, which is the core of their responsibilities in their profession, as members of a team, midwives also must exercise and exhibit effective communication with their peers and administrative bodies as well.
Supervisors are an important part of this process in that they are there to assist and help midwives stay abreast of new developments, evaluate and aid them in enhancing their care delivery as well as being working partners in the midwife / patient relationship (Nursing & Midwifery Council, 2008d).
The supervisory practice aids midwifes in their accountability, as well as assisting them in their potential or real communication issues with patients, and stand as an aid in the process. Their role in the effective monitoring of midwifes is in the interests of the public as well as the midwife, through their ongoing monitoring of midwives (Nursing & Midwifery Council, 2008d). Jones and Symon (2000, p. 27) point to the preceding as being one of the strengths of the profession in the UK, “…the statutory supervision of midwives”. They state that the system’s priorities are the assisting of midwives in the assessment of their own needs, as well as those of their patients, maintaining the adherence to the Code as their guide (Jones and Symon, 2000, p. 27). The preceding is referred to as ethics that represents the role of midwives, their supervisors and the entire structure of health care that is in the public trust. The aforementioned layer of accountability has been established to oversee midwives as well as provide them with a framework to foster communications with patients, and also provide patients with a structure as well. Good communication, as stated throughout this study, wards off potential issues and problems, and is the cornerstone in establishing effective care for the midwife and patient. Its importance cannot be over emphasised, as miscommunication in health care can have consequences that are life threatening.
Devries, R., Wrede, S., Teijlingen, E., Benoit, C. (2001) Birth by Design: Pregnancy, Maternity Care, and Midwifery in North America and Europe. Routledge. London, United Kingdom
Ellingson, L. (2002) Communication, Collaboration, and Teamwork among Health Care Professionals. Vol. 21, No. 3. Communication Research Trends
Jones, S., Symon, A. (2000) Ethics in Midwifery. Mosby Publishers. Edinbergh
McCabe. C. (2004) Nurse-patient communication: an exploration of patient’s experiences. Vol. 13, No. 1. Journal of Clinical Nursing
Medical news Today (2007) Resuscitation of Patients, UK. 1 November 2007. Medical News Today
Nursing & Midwifery Council (2004b) Complaints about unfitness to practise: A guide for members of the public. Nursing & Midwifery Council. London, United Kingdom
Nursing & Midwifery Council (2004a) Midwives rules and standards. Nursing & Midwifery Council. London, United Kingdom
Nursing & Midwifery Council (2008d) Modern supervision in action: a practical guide for midwives. Nursing & Midwifery Council. London, United Kingdom
Nursing & Midwifery Council (2004c) Reporting lack of competence: A guide for employers and managers. London, United Kingdom
Nursing & Midwifery Council (2004d) Reporting unfitness to practise: A guide for employers and managers. Nursing & Midwifery Council. London, United Kingdom
Nursing & Midwifery Council’s (2008c) Support for parents: How supervision and Supervisors of Midwives can help you. Nursing & Midwifery Council. London, United Kingdom
The Nursing & Midwifery Council (2008a) The Code Standards of conduct, performance and ethics for nurses and midwifes. The Nursing & Midwifery Council. London, United Kingdom
Nursing & Midwifery Council (2008b) The Prep handbook. Nursing & Midwifery Council. London, United Kingdom