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Midwives׳ clinical reasoning during second stage labour: Report on an interpretive study
Elaine Jefford1, Kathleen Fahy2
1Southern Cross University, School of Health & Human Sciences, Coffs Harbour, NSW 2450, Australia.
Midwifery
|February 10, 2015
Summary
Midwives demonstrate clinical reasoning skills, but less than half consistently use it for decisions. A new model values intuition alongside clinical reasoning for transparent decision-making.
Area of Science:
- Midwifery
- Clinical Reasoning
- Healthcare Decision-Making
Background:
- Clinical reasoning was historically confined to medicine, excluding fields like midwifery.
- Deficiencies in clinical reasoning and decision-making contribute to adverse maternity care outcomes.
- Existing midwifery decision-making models lack practical detail for guiding reasoning.
Purpose of the Study:
- To investigate the extent of midwives' engagement in clinical reasoning during labor.
- To explore how midwives make decisions in the second stage of labor.
Main Methods:
- Interviews with 26 practicing midwives.
- Feminist interpretive analysis guided by a clinical reasoning model.
- Analysis of midwife narratives to understand decision-making processes.
Main Results:
- A new model of Midwifery Clinical Reasoning was developed.
- 13 out of 20 participants showed analytical clinical reasoning, but only 9 fully implemented decisions.
- 7 midwives used non-analytical decision-making without sufficient assessment validation.
Conclusions:
- Over half of midwives possess clinical reasoning abilities.
- Less than half consistently employ clinical reasoning in their decision-making.
- The new model incorporates intuition as a valid 'way of knowing' but emphasizes its complementary role to transparent, validated clinical reasoning.
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