Clinical reasoning education could improve midwifery outcomes: Research

The safety and effectiveness of midwifery practice in Australia could be improved with more in-depth education relating to clinical reasoning and decision making, a Southern Cross University study has found.

In their recently published paper, Midwives’ clinical reasoning during second stage labour: Report on an interpretive study, Dr Elaine Jefford and Professor Kathleen Fahy of the University’s School of Health and Human Sciences investigated how midwives make decisions and what conditions affect their decision making.

Dr Jefford undertook the world-first study as part of her PhD, which was conducted using clinical narratives of 26 practising midwives from various services across Australia.

Two narratives were collected from each midwife - one the midwife deemed an example of good clinical-reasoning and the other of poor clinical reasoning. These were assessed against a decision-making framework devised by Dr Jefford.

“Professional standards around the world recognise the importance of midwives’ decision-making during childbirth and the health and safety of women and babies during childbirth critically depends on midwives’ decision making skills,” Dr Jefford said.

“The key to a high standard of care is effective clinical decision-making, yet great variation in midwives’ decision-making processes at the time of birth has been identified.

“In Australia universities and around the world there are no standards on how or where in the curriculum to teach clinical reasoning or decision-making skills to students of midwifery or how to refine these skills.

“These inconsistencies undermine the effectiveness and application of midwifery education in to practice, as well as hindering a midwife’s professional autonomy and the discipline generally. Ultimately, the health and safety of women and babies is compromised.”

The research concluded midwifery regulatory authorities should revise professional decision-making frameworks to explicitly reflect analytical clinical reasoning and that bodies overseeing midwifery education introduce clinical reasoning into midwifery curricula for teaching and assessment.

Dr Jefford said the Australian College of Midwives (ACM) had endorsed the research and was investigating how its outcomes might complement the ACM National Midwifery Guidelines for Consultation and Referral.

In collaboration with other researchers, Dr Jefford is in the process of developing an online learning package focusing on clinical reasoning and decision-making for students of midwifery. According to Dr Jefford, the online package will provide a structured, comprehensive and transparent theoretical and philosophical approach to decision-making processes and their application to midwifery.
Photo:Research by Dr Elaine Jefford has found clinical reasoning education could improve midwifery outcomes.