I was never much on theoretical anything. I worked in a solo practice (just me) in a community where I was the only female provider as well as the only midwife for 50 miles. I thrived on the rush that participating in the miracle of birth provided that I just didn't give the why and how of my practice much thought. It just seemed to make sense...the process worked the way it was designed. It was only after 10 years or so and working along side many MDs and nurses who didn't view birth the way I did that I began to think there might be some basis or foundation other than my own thoughts and feelings for midwifery practice.
There has long been a debate about the relationship between feminist theory/feminism and midwifery. Bill McCool addressed this in the late 80's with his classic article. Cragin did an anlysis of three different theories of midwifery practice. Theory development in midwifery practice is still evolving.
Share you thoughts on these three questions:
1. What are your general thoughts and relfections on the three framework models in the Cragin article?
2.How is feminist theory consistent or not consistent with nurse-midwifery practice?
3. Is it even important to have a theoretical basis for practice? Why or why not?
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1. Thoughts/reflections on the three framework models discussed in the Cragin article?
ReplyDeleteI enjoyed reading these articles. It was a good history review in regards to midwifery and a thorough examination of the importance of theory in midwifery practice. All three theories discussed the influence of midwifery care in relationship to positive outcomes and stressed the importance of women as active participants in structuring their own care. Additionally, they emphasised the normalcy of childbirth and the midwife's vital role in this aspect of care. Each theory makes a unique contribution to the importance of midwifery practice in relation to other professions, which is key in validating our work.
Although Lehrman's theory explains basic midwifery care and is the basis of the development of theory in midwifery practice, and Thompson describes the major concepts in the approach to nurse-midwifery care, I definitely related to Kennedy's dynamic model of care by an exemplary midwife the most. In the article it states, "The exemplary midwife supports the woman in a manner that preserves the woman's personal power and dignity." I like the focus on "exemplary midwife" because it emphasises how midwife's can empower women with their support and guidance. To be exemplary is to focus on the woman and go above and beyond to enhance her health and well-being. The qualities of exemplary midwifes have a positive relationship with the approach to care used and these approaches have a positive relationship on the outcome. I think it is the most holistic and supportive theory in relation to our profession.
2. Is feminist theory consistent/not consistent with nurse-midwifery practice?
Overall I think feminist theory is consistent with nurse-midwifery practice in that nurse-midwifery practice includes the perspective of the female experience, empowers women, and is gender sensitive. I was surprised when I read in the McCool article that lay midwifery is more closely linked to feminism and that nurse-midwifery's close link with the medical profession puts it in a difficult position for viewing and maintaining women's health from a women-centered perspective. That kind of floored me because I think of midwifery practice as "women taking care of women," and in that I see midwives as women's advocates and greatest champion. I understand our link to the medical profession and see where the association can be made, but it kind of shocked me to read that! However, what shocked me even more was to read further and see noted the obstacles between nursing and feminism due to nurses being seen as subordinate and supportive of the medical model of care because they work under "doctor's orders." I realise this article was written over a decade ago, but it still threw me for a loop to see these things written. I see nurses as patient advocates that have the power to protect the patient's from the medical model if necessary and provide them with more holistic care. In conclusion, it would seem that the feminist theory has positively directed some nurse-midwifery research, but in my opinion it need not be the basis of all midwifery research, but a component of it.
3. Is it even important to have a theoretical basis for practice?
Yes, as all my past research teachers have proven to me. :-) Theories are guides to problem solving in clinical practice. They assist us and other clinicians in understanding why particular interventions are or are not effective and guide our practice. For example, Lehrman's, Thompson's, and Kennedy's theories propose and explain the constructs and concepts that describe the domain of midwifery practice. They validate our practice and produce specific connections between care and outcomes that can serve as guides in clinical practice and midwifery education.
I hope my answers have made sense. I could not sleep tonight (working night shift can have a negative effect on me sometimes) and therefore decided to get some work done. I look forward to discussing these questions with you all! :-)
Kim
1. What are your general thoughts and reflections on the three framework models in the Cragin article?
ReplyDeleteI enjoyed reading about specific theories related to nurse midwifery. After review of the article by Cragin I found that the Lehrman theory meets all the criteria for theory development. The theory can generate a testable hypothesis and hold potential to guide practice for nurse midwifery, but so do Thompson et al and Kennedy theories. The difference in the Lehrman theory and the Thompson et al and Kennedy theories is that the Lehrman theory has parsimony or thriftiness about the theory. I relate to the emphasis of Lehrman to the importance of women as the focus of the theory. This theory is based on the ACNM philosophy itself.
The broadness of Thompson at el theory gives freedom of the prescriber of this theory for growth and flexibility. However, the theory is difficult to test and analyze. Further work on this theory would be beneficial in the further analysis of its concepts.
Kennedy’s model gives two assumptions: first that the midwife who provides exemplary care bases his or her care on the philosophy and standards of care set by the ACNM, and second, exceptional care more likely will have a positive outcome for the women and/or the infant. I also believe this assumption can be part of all theories of midwifery.
All of the models utilize a feminist approach to the care of women as a specific group who has their own set of needs.
2. How is feminist theory consistent or not consistent with nurse-midwifery practice?
The principles held by midwives throughout history have been consistent with the uniqueness of women and their needs and desires. However, the nursing practice has not been and is one of the last areas to become more feminist friendly. Nursing history has been long in being the handmaiden to a patriarchal dominated medical system. Although the history of nursing is much shorter than that of the midwife. It is only recent history that has put the two professions together. It is the long standing history of women providing the care to the special needs of other women in midwifery. This is a true model of feminism. What more could be more true and pure in nature than the needs of women during parturition?
3. Is it even important to have a theoretical basis for practice? Why or why not?
I think as a nurse starting my career, theoretical nursing was not of any importance to me. I was more tasks oriented and wanted to learn tasks and procedures. As my nursing career grew, so did my critical thinking skills. While studying for my Bachelorette degree, I found that theory of nursing practice important in understanding how nurses make their own individual impact on health care. Nurses are unique in their own right, not just to assist physicians and be caregivers only. This was the beginning of the discovery of theory based philosophy of care. As a midwife and women’s health nurse practitioner it becomes more important to understand theory to base a philosophy of care on. This philosophy of care that is unique to our profession is the care of women and their needs. Understanding how history has impacted women, their care during times throughout their lives and how as caregivers to women’s needs our philosophy of care and theory behind that care impacts how we relate to our patients.
Kim;
ReplyDeleteI enjoyed your look at constructs, and concepts of the theories. I too enjoyed relating all of the theories to hwo I feel the practice of nurse midwifery is. I too relate to Kennedy's theory. To me excellence in care and personal interactions directly effects outcome and patients preceived experience in a positive nature. We all know being educated in safe effective care along with the personable nature of providing care can lead to a patients positive experience.
Good work Kim
1. What are your general thoughts and reflections on the three framework models in the Cragin article?
ReplyDeleteI thought this article did a really nice job of breaking down nursing theory in general and these three theories in particular. As someone who finds nursing theory to be a particularly dry topic, I appreciated how the three theories were compared in contrasted very succinctly.
Of the three, I identified most strongly with Kennedy’s theory. I agree that in order to be an “exemplary midwife” one must practice within the standards established for midwifery and by doing so, positive outcomes will follow. I also like that Kennedy emphasizes knowledge of one’s own limitations as well as a recognition of birth as a normal process.
2.How is feminist theory consistent or not consistent with nurse-midwifery practice?
This is an interesting question to debate. I understand where the author’s of the article were coming from when they mentioned that the nursing profession has been looked down upon by feminists who say that we are being subjugated by physicians who call upon us to do their bidding. I personally have never felt that way. Though I could have pursued a medical career, I purposely chose to pursue nursing. I enjoy having the one-on-one time to educate my patients and answer their questions or translate what the doctor said during his/her brief flyby. And the medical profession itself is not nearly as male-dominated as it used to be; probably half of the OB/Gyns I work with now are women.
As far as nurse-midwifery and how it relates to feminism, there are obviously many issues on which they agree: empowerment, self-determination, viewing pregnancy and birth as a natural process rather than a disease, etc. But I don’t think that the two schools of thought are necessarily married to each other either. You can certainly be a nurse-midwife and not a feminist.
3. Is it even important to have a theoretical basis for practice? Why or why not?
Yes, I think it is important to have a theoretical basis for practice. In order for nurse-midwives to be taken seriously, we must define our role and adhere to our standards of practice. Having a theoretical basis for practice gives focus and direction and ensures that we are all on the same page.
1.What are your general thoughts and reflections on the three framework models in the Cragin article?
ReplyDeleteI think the Cragin article did a good job at discussing the strengths and limitations of the theories being presented. The substance of each theory was broken down in a way that was easy to understand. It was easy to relate each theory with midwifery care.
I also identified more with the Kennedy theory. This theory addresses more than just interventions “performed” on the patient. Individual qualities of the midwife can have a positive or negative effect on the patient. These qualities include a solid knowledge based, an understanding of individual skill level, a positive attitude, a sense of persistence, and a sense of commitment can improve patient care.
2.How is feminist theory consistent or not consistent with nurse-midwifery practice?
I think the feminist theory is consistent with nurse-midwifery practice. Feminism focuses on women and improving gender inequalities. The feminist theory proposes that women should be able to direct their healthcare. Care provided by nurse-midwives is woman centered, and women are allow to participate in the development of their plan of care.
3. Is it even important to have a theoretical basis for practice? Why or why not?
I agree with Erin’s statement. Nurse-midwives will not be taken seriously without defining what role we want to play in the lives of women. Care management decisions are based on the midwife’s beliefs about what midwifery is and isn’t. A midwife must determine what beliefs guide her practice so that she can discuss those beliefs with her patients. This process ensures that each client can find a midwife that shares her philosophy.
1.What are my general thoughts/reflections on the three theoretical frameworks in the Cragin article?
ReplyDeleteOverall all three of the frameworks summarized that the primary focus should be patient centered. However, Lehrmans theory was much more patient driven. Lehrman focused on the past health experiences of the patient as being a driving force for care and decision making.
I agree with Amanda in that I personally identified with Kennedy's theory than either of the others. While I understand and concur with Thompson that midwifery care does make a significant difference in a woman's life,but it is the extraordinary care of the midwife that sets us apart from any other discipline. This was more the focus of Kennedy's theory. Midwifery strives to be different. Midwifery is vigilant in preserving the dignity and personal power of women when it comes to their being an active participant in their health care. As well as midwifery does not look for the cookbook solution to healing, but rather individualizes care by promoting health and ensuring that every action taken is the correct action and yields the desired result.
2.How is feminist theory consistent or not consistent with midwifery practice?
Both theories focus on a woman centered care approach. Both believe in the empowerment of woman and a partnership in decision making. Both recognize the extraordinary ability of women to transcend what would appear to be an insurmountable obstacle. Lastly, both fight for the rights and the equitable health care of each woman.
3.Is it even important to have a theoretical basis for practice? Why or why not?
It is extremely important that there be a theoretical basis for midwifery. Just like the code of ethics or Hippocratic oath of medicine, midwifery must have principles to guide our decision making based upon fact and sound doctrine. Theoretical frameworks gives each midwife a foundation to build her practice philosophy and establishes her beliefs.
1. What are your general thoughts reflections on the three theoretical framework models discussed in the Cragin article?
ReplyDeleteThis article was good for me to read and consider. I have never been too much for theory so having this article give a brief overview of each theory was very helpful.
Ernestine Wiedenbach's theory is a good nursing theory that was probably very relevant when she wrote it. I believe that nursing care and the needs and desires of patients are very dynamic and have a different face today. There are a lot of good things about the theory but I disagree with her idea of "first identifying a "need for help" in the patient. I personally think that excellent midwives are intuitive and pre-think those "needs for help" and many times take care of them before the need occurs. This type of care is what makes a good birth experience a top-notch birth experience.
Lehrman's theory is a great springboard for any practicing midwife. It covers many of the basics of practicing good midwifery. I like that she incorporated ACNM's philosophical view and that she actually spoke with midwives in order to get their insight to develop her theory.
The theory offered by Thompson and colleagues is interesting because it encompasses the patient as a whole and considers her health as a picture her environment - habits, socioeconomic status, etc. I can personally see this in many of the patients that I have provided care for.
2. How is feminist theory consistent or not consistent with nurse-midwifery practice?
ReplyDeleteIt is apparent to me that feminism does not embrace nurse-midwifery. It seems that those who declare feminism would loudly proclaim the positives of any vocation that is primarily occupied by women and that primarily provides services to women. My personal thought is that feminists might think that nurse midwifery invokes a negative thought that only women should care for other women and that it might be belittling.
I don't think feminism is consistent with nurse-midwifery practice. I believe that nurse-midwives have a passion to serve families, not just women. Nurse-midwives are proud of their vocation, their education, their art and their talents. In no way do midwives see themselves as "second fiddle" to other professions or men who do the same jobs.
3. Is it even important to have a theoretical basis for practice? Why or why not?
ReplyDeleteOn a day to day basis in the clinical setting, I have never put much thought into specific theories. Of course I am aware of them and realize that some of my personal thoughts and convictions line up with different theories. I think that I rely more on my personal feelings about providing care, working with the client to determine her best plan of care, utilizing evidence based care, and mixing in a little of my intuition. After reading these articles I have come to decide that I really do need to put more stock into the theories and incorporate them into my practice since they do provide a springboard for clinical decision-making.