• Gitte Bjørnlund
Abstract This project is prepared at the Master of Learning Processes at Aalborg University during the fall of 2014 and is written by Gitte Bjørnlund, senior educational midwife. The study investigates the opportunity of midwife students to learn to adopt independent professional midwifery judgments during the clinical part of their education. The background of the study is the fact, that the clinical education has been organized in such a way that the students mainly learn by participating in midwifery work with pregnant and parturient women. However, in recent years the conditions of the midwifery work have changed markedly, following the efforts of the hospital organization to standardize treatment on the basis of general, professional guidelines based on medical research. This situation implies that several interests and values come into play, thus actualizing a potential contrast between on the one hand the historical tradition of the midwifery profession to care for the individual woman on the basis of midwifery judgment, and on the other hand a more generalized treatment model. The starting point of the project has been a presumption that midwifes work, when thus loaded in more fixed frames, will change the students´ learning conditions. Based on this the following question is raised: How can an evidence based practice exercise influence midwife students’ opportunities to learn to adopt independent professional midwifery judgment through the clinical part of the education? The aim of the study is to investigate and make didactic reflections on the following: • What does the phenomenon “professional midwifery judgement” imply? • How do the changed frames around midwifery work influence the practice exercise, and which learning conditions does this bring to the students’ opportunity to learn to make independent midwifery judgement? Methods: The project, based on hermeneutics, mainly takes a literature study as a starting point, by which, through studies of different theoretical perspectives, a varied understanding of the complex phenomenon, professional midwifery judgement, is achieved. Professional research is used to study and achieve understanding of the influence on the practice exercise by the framing of midwifery work as done by the hospital organization. A former exercised observational study of the practice of two midwives is included to investigate, how two different approaches to practice exercise based on professional guidelines leads to different learning conditions for the students. Findings: The midwifery profession has, by society, been appointed the task of taking as one’s starting point the pregnant individual’s wants and needs, and to exercise an individual and differentiated care, focused on supporting the normal development of the pregnancy and birth process. Based on the work of researchers Grimen & Molander, who have studied the professional judgment on a general level, the professional midwifery judgement can be presented thus, that the midwife, focusing on supporting the development of an uncomplicated pregnancy and birth process based on professional guidelines, in concrete, isolated cases must make a judgment of, what serves the individual woman best. The nursing theoretician Kari Martinsen highlights the fact that the objective-rational reason embedded in professional guidelines, out of which midwifes must classify the concrete situation, might lead to a problem solving focus. Thereby the risk arises, that a limited impression of the individual woman’s situation is formed, which reduces the possibility of a qualified judgment as to what serves the individual woman best. Lennart G. Svensson states that the effort of the hospital organization to achieve a minimum of control of the work through professional guidelines interacts with the professional autonomy as appointed to the midwifery profession by society, thus being in a direct and tense opposition to a more individual-centred treatment model. His research shows that the individual midwife, being in the dilemma between the consideration for the individual woman and the hospital organization, is socialized into and adapting to a practice exercise in concordance with the professional guidelines, and is thus to a certain degree bound to be practicing in concordance with the values and perspectives of the hospital culture. The research of Billie Hunter shows that this leads to a practice exercise based on a less complex professional judgment. As far as the students are concerned, and according to Donald Schön, this again leads to educational learning conditions, where the students only to a lesser degree can succeed in developing an embedded, professional knowledge, which in turn can limit their ability to handle complex practice situations.
SpecialiseringsretningDidaktik og Professionsudvikling
Udgivelsesdato18 dec. 2014
Antal sider60
ID: 206631223