In Florence s Footsteps: Exploring values and beliefs in novice nurses and midwives Anna O Connell
What does it mean to be a nurse/midwife? https://www.youtube.com/watch?v=zfwfagnbnk0
Why this study? Prof Philip Darbyshire- ANMF Conference, 2014 The Mid Staffordshire Trust scandal and the Francis Report: Could it happen here? (Darbyshire, 2014) Multifactorial picture of abject failure of healthcare and nursing standards Mid Staffordshire NHS Foundation Trust 2005-2009 Extensive examination and enquiry led to The Francis Report - Sir Robert Francis, QC.
The Francis Report Published February 2013, authored by Sir Robert Francis, QC Recommendations include recruiting nurses with the right values, attitudes and behaviours (Francis, 2013) and who would care for their patients more than themselves Industry response: Agreement- nurses don t care as much as they used to Renewed focus on patient centred care Work towards reform: encourage speaking out
What are core nursing/midwifery ethics? Caring defines nursing, as curing often defines medicine (Lachman, V 2012) What would Florence do?? How do ethical behaviours and beliefs contribute to patient care as well as personal career satisfaction? Can one sustain the other? What happens if your values slip?? What does this mean for the retention of nurses and midwives in an increasingly reduced workforce?
Study Details Qualitative study employing interpretive phenomenological methodology Completed under auspices of Deakin University and Monash Health 7 participants interviewed using semi-structured, informal process- all duel degree nurse/midwives: most working in Midwifery: some in both areas Participants were current employees of Monash Health having completed their Graduate year in 2015
Data analysis Interviews were taped with participant s consent Researcher listened to data at least twice then verbatim transcripts were created for further analysis Data was coded and themed for significant details and responses Interview questions focused on the participant s initial stimulus to become a midwife/nurse feelings about their chosen career, their pride (or otherwise) in their role, and the stressors that made the role difficult (if any)
Themes Twelve initial codes were organised into four main themes Participants demonstrated a degree of cohesion in some responses- repeated phrases and terminology Themes: Caring Motivation Professional Pride Self-Care
Caring The Francis report- nurses who care for others more than themselves Erin: No matter what, you ve got to put yourself in their shoes; Um, you ve got to understand how they re feeling, one of my biggest things is you ve got to put yourself in someone else s shoes. Rebecca: Put yourself in their shoes, and like, is that the way you would like to be cared for?
Caring Frustration at not being able to provide adequate care Erin: That s disappointing, that sometimes I m scraping through bare minimum on some shifts, its like, right, they re alive! (laughs),
Caring Caring for colleagues Julia: To pass on knowledge and experience to someone else was just..it was just a real joy. If I can continue to make a difference to future midwives as well..that s really special.
Motivation Inspired by others including those they care for Specific role models- Catherine Hamlin (Adis Ababa Fistula Hospital) Nurses/Midwives who had cared for them or their families Empowerment -phrase repeated by almost all of the participants- satisfaction in motivating women/patients to care for themselves, their babies or their families.
Motivation Rebecca: taking into account their values as well as making sure what they want is being listened to.. they re in control, not really me Erin: Not just that we ve made a difference, but that they ve made a difference to us..you had such a special time with them. Julia: Empowering women and make them feel that they can do it..i think it s so important to help women..to go home feeling confident
Professional Pride What does it feel like to say I m a midwife/nurse? Miriam: (laughs) I get all puffy-chest syndrome my partner calls it!..but yeah, I m very proud to say I m a midwife. Erin:..we have a lot of medical knowledge and make a lot of big decisions... managing a huge PPH [Post-Partum Haemorrhage] if the doctors aren t there yet..sometimes, like my family or my boyfriend, I think Oh, I wish you could see me.. in a delivery and see..what I actually do, that would be so awesome!
Professional Pride Teamwork- good and bad experiences Erin: It s more of an acknowledgment of the teamwork..it s not so much like..individual praise.. it s that recognition of the team Lily: I feel like there are important things women need to know.. And if it hasn t been done, then I feel like that s..not the standard of care that we should be giving.
Professional Pride Miriam: You re always going to have people who are just in the job for the money and they ve done it so long, they probably shouldn t be doing it?..but then you d pick up from other midwives how fantastic they were in the way they talked to people and the skills and the knowledge that they have which just..inspired me to keep going, keep going!
Self-Care The Graduate Precipice -support withdrawn Rebecca: After being a grad and having support, support, support and, not that there s not support there, but.. like..the un-confident, un-motivating days..it s like, why would I come?..if you don t get births and you don t get to do stuff, you don t get skills!
Self-Care Miriam: I know that if I work too much I turn into a little bit of a nutcase at home.. I feel a little bit..withdrawn from family life, like, I m just too knackered.. Erin: I really hurt my back a little while ago, and I was like, hmm..probably shouldn t go to work but I did anyway..but if you care more for your patients, like that s nice, but if you can t look after yourself, then how are you going to look after your patients?
Self-Care Erin: Just come and work a shift, just once! Come home with me and see me in my car after an awful shift..that whole put yourself in my shoes thing.. Claire: Everyone has their bad days,but..not being appreciated by the Organisation or staff..that would make me kind of..not really be the best I could be.
Summary Miriam: She said I had the time for her and that I listened and that I treated her like a sister, so then I thought to myself, well, I must be providing that care..that care that had initially inspired me to become a midwife.
References Australian Nursing and Midwifery Federation, 2016, Unlocking endemic bullying facing new graduates, Australian Nursing and Midwifery Federation Journal, vol. 24, no.4 Darbyshire, P, 2014, The Mid Staffordshire Trust scandal and the Francis Report: Could it happen here? ANMF Conference plenary session, Melbourne, 2014. Department of Health, 2014, Nursing Workforce Sustainability: Improving Nurse Retention and Productivity, Canberra, Fagermoen, M 1997, 'Professional identity: values embedded in meaningful nursing practice', Journal Of Advanced Nursing, 25, 3, pp. 434-441 8p, Lachman, VD, 2012, 'Applying the Ethics of Care to Your Nursing Practice', MEDSURG Nursing, Vol.21, no.2, pp. 112-116 5p. Stamm, B.H. (2010), The Concise ProQOL Manual, 2nd Ed., Pocatello, ID: Thomas, G, 2013, Global health workforce shortage to reach 12.9 million in coming decades, news release, 11 th November, World Health Organisation Thoms, D, 2016, ANMF Plenary session, Melbourne 2016. Todaro-Franceschi, V,2013, Compassion Fatigue and Burnout in Nursing : Enhancing Professional Quality of Life, Springer Publishing Company, New York.