AbstractObstetric emergencies are a rare event; however, when they occur, experienced midwives if not already present may be summoned to manage the situation until the arrival of the obstetric team. Concerns around sub-standard care in the recognition and management of obstetric emergencies persist. This is in spite of the expansion of and up-dating of clinical guidelines, the development and recommended use of early warning scores (EWS) coupled with yearly mandated, enhanced multi-disciplinary skills and drills training.
In view of the above, the aim of this study was to understand and explain the decision making processes of experienced midwives as the primary responders during obstetric emergencies and to develop a substantive explanatory theory of emergency decision making.
An Interpretivist Case Study design using constant comparative method and analytical strategies that draw from dimensional analysis was adopted. Data collection comprised of a biographical questionnaire, researcher generated video elicitation methods with informal researcher observation as a companion method and document review of local and national guidelines in the management of obstetric emergencies. Participants were seven experienced midwives from 3 NHS Trusts.
Findings suggested that the effect of watching themselves and others in a representational world (videos of obstetric emergencies), triggered the midwives to become self-aware of their own behaviour within the representational world and from their past experiences. Positioned as sitting on the edge of the representational world, conceptualised as the window to the world, they self-regulated their behaviour. First, they positioned themselves relative to others and objects to explain, support and excuse specific decisions and actions. Second, they became the non-diegetic narrator reflectively reconstructing events in the representational world and from past experiences. It is proposed that their retrospective assessment and subsequent understanding of these experiences labelled as the wisdom of hindsight may have resulted in some cognitive reconstruction and modifications of the events within the experiences that favours their position of experienced midwives. These defensive strategies were used to affirm their knowledge, judgement and decision making and self-guard their reputation as experienced midwives. Significantly, the midwives were implicitly operationalising their knowledge, judgement and decisions in a way that self-guarded their reputation.
The emergent substantive theory of self-guarding through a window to the world extends the notion of positioning, hindsight bias and guarding identities. This has implications for practice and education with respect to how practitioners reflect and learn and the impact of this on patient safety.
|Date of Award||Aug 2019|
|Supervisor||Nina Dunne (Supervisor), Julie Scholes (Supervisor) & Professor Simon Cooper (Supervisor)|