Andrea Taylor, Post Graduate Prizewinner at the University of Edinburgh tells us about putting person centred care into practice.
As a Community Midwife within NHS Lothian, I was offered the opportunity to undertake a Person Centred Care in Practice (PCCiP) MSc module at Edinburgh University Summer School in 2014. This allowed me to explore women centred care within midwifery through models and frameworks used in nursing care and introduced me to new ways of seeing.
During the module I began to reflect on how, fundamentally, midwifery, as a practice and model grew naturally within the realms of women centred, relationship based, compassionate care. The role of the midwife evolved from the needs of women, it has not been created via a medical model. Yet, due to the way midwifery has been shaped through obstetric authoritative knowledge, streamlining and centralising I began to question if midwifery remains a relational, women or person centred model.
The MSc module also coincided with my first anniversary in the role of Supervisor of Midwives (SoM) thus encouraging reflections on the ‘person centredness’ of supervision and midwifery leadership roles. Using the concepts of health assets, emotional labour, Co-production and Nolan’s Senses Framework I began to reflect on aspects of relationships within midwifery practice. For the assignment I focused specifically on relationships between the supervisor, the supervisee and explored the framework of supervision that recognises supervisors of midwives as leaders.
Yet, early this year, after funding an independent review into midwifery regulation the Nursing and Midwifery Council (NMC) announced it upheld the recommendations of The King’s Fund report, that statutory midwifery supervision no longer be part of the NMC legal framework (The King’s Fund 2015, NMC 2015). In light of this and the Kirkup Report (2015) the future of supervision and the role of SoM is now debated by midwives across the country including on social media. During one discussion on Twitter with the Royal College of Midwives (RCM) Director for England, Jacque Gerrard, I shared that I had written a personal reflection on the topic of SoM and person centred care and offered her the opportunity to read it. I received excellent feedback from Jacque and with her encouragement I sent the article to the editor of the British Journal of Midwifery where, after peer review and some minimal editing it was published in May 2015.
I’m thrilled and really hope my article (subscription required) will stimulate debate about the future of supervision and highlight the emotion work involved in midwifery and in the SoM role.
As I discussed with sociology PhD students and researchers recently at a workshop with Barbara Katz Rothman, Professor of Sociology at the City University of New York, it’s not easy putting your work out there, especially personal reflections, and possibly having to discuss and defend it. If you believe in it then just do it or as social media extols us these days #JFDI!
After successfully completing the PCCiP module I chose to continue with the MSc in Advanced Clinical Skills at Edinburgh University and was thrilled to hear I had won the Post Graduate Prize for 2015 from The Queen’s Nursing Institute Scotland.
As part of my prize I was invited to attend the QNIS Annual Conference where I found the discussions and presentations in regard to nursing and specifically community nursing extremely contemporary, innovative and political.
This reminded me of being a post graduate midwifery student on the PCCiP module where I discovered the benefits, educational and relational, of working alongside health care professionals from different departments. As midwives, nurses and allied health care professionals we do not work in isolation, the value of shared learning, reflection and working relationally, especially within the current challenges of healthcare, is huge. Interdependence and interrelationships are to be embraced especially at a time when person centred care and its framework is on the national agenda
Professor Brendan McCormack from Queen Margaret University discussed ‘Humanising the Care Experience’ in his presentation, his comments on the risks of principles of person centred care only focusing on patients and not the people delivering care reminded me of research from Faye Thompson, who carried out a narrative enquiry into emotions and feelings around ethical midwifery practice and decision making (2005). Thompson highlighted the need for patient care and employee care to be equally reflected in the ethics and philosophies of our health organisations and authorities.
Such ethical principles and practices, based on relationships, may offer great benefits to healthcare. I am intrigued by the work at Dumfries and Galloway Maternity Unit where they have recently increased the natural birth rate to 70%, the highest rate in Scotland for 20 years. This is reportedly due to a person centred care approach taken with mothers and staff. Person centred models of leadership should encourage care of staff at the frontline, ensure conditions facilitate their clinical work, professional development and morale. In turn this can perpetuate positive relationships. I would suggest creating and structuring models of care that establish relationships are fundamental in improving patient safety and experience.
Andrea Taylor
Community Midwife
NHS Lothian
Andrea’s article in the British Journal of Midwifery is available here, although a subscription is required.
