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Caring for women: the potential contribution of formal theory to midwifery practice.

OBJECTIVE
To explore the interpretations midwives and nurses attach to the concept of caring, how caring values are manifest clinically and might be encouraged educationally.


DESIGN
Ethnographic fieldwork was undertaken in UK National Health Service palliative and maternity-care hospital settings for 12 and 10 days respectively. This involved non-participant observation, semi-structured, audio-taped interviews with seven midwives and six nurses. Ad hoc conversations with service-users were also undertaken and contextual information, such as staffing levels, was collected. The data were thematically analysed against a conceptualisation of caring developed from nursing and philosophical literature.


FINDINGS
Comparison of observational and interview data across the settings identified qualitative differences in care delivery. In the palliative care setting, practice was other-centred, receptive, responsive and attentive to the patient's person and experience. In comparison, caring values appeared eroded in the maternity setting, where practice was often routinised, task-orientated and, on occasions, unresponsive to women's needs. Features existed in the palliative care setting which appeared instrumental in facilitating a caring practice culture. In particular, clinical leaders facilitated team cohesion through daily 'debrief' meetings and care enhancement against theoretical frameworks. These encompassed caring values and provided the source of problem identification and remedial strategy. No such collective, theoretical perspectives were evident in the maternity setting.


DISCUSSION AND IMPLICATIONS FOR PRACTICE
Whilst acknowledging the limitations of formal theory, it is suggested that midwifery goals and priorities of care could be utilised to theoretically frame, critically evaluate and guide practice. This has the potential to heighten awareness of care deficits and enable midwives to work collectively to enhance women's experience of childbirth at both clinical and political levels.