Complex Care Scenario Assignment – Brainstorming

Essentials for ALL Scenarios

• Explore the principles of shared decision-making. What benefits, challenges and obstacles are there?

• Refer back to the scenario throughout your work, but use it as a basis for and illustration of your discussion of the decision-making process, rather than as the focus of your assignment. The assignment should highlight how (if?) the concept of shared decision-making is implemented in the clinical area (i.e. the interdependence of theory and practice).

• The assignment is not just writing a Care Plan for the scenario – it’s more about discussing why these clinical decisions might be taken, rather than simply describing what these decisions are.

• Examine the rationale behind the various decisions that could be made by the woman, by the midwife, and by the larger MDT. Rationale, for everyone involved in the decision-making process might include:

– professional guidance (e.g. RCM, NMC)

– evidence-based practice

– research

– clinical experience

– professional values and obligations (e.g. promoting public health, advocacy, confidentiality)

– professional confidence (e.g. readiness to challenge senior colleagues)

– personal experience and attitudes (e.g. anxiety due to previous childbirth experience)

– personal and social circumstances (e.g. family support)

– personal values and perceptions.

• Explore the conflicts that might arise due to the different rationale? How would you / the midwife address these challenges?

• Reference all statements about shared decision-making, woman-centred care, professional issues and values, best clinical practice, and policies, guidelines and statistics.

• Critically analyse the literature you use: is it valid / reliable / accurate / relevant / representative of what’s happening in the clinical area? Does more research need to be undertaken on the topic?

• Summarise the implications for midwifery practice – your own clinical practice, and midwifery practice as a profession.

VBAC Scenario

• VBAC in context

– Benefits, risks, challenges

– Research (e.g. statistics around maternal and neonatal morbidity)

– Professional guidance (e.g. NICE, RCOG, RCM)

– Potential outcomes

– Alternatives: planned CS, “failed” VBAC → emergency CS

• Range of professional issues and obligations linked to shared decision-making, including:

– Advocacy

– Communication with woman and MDT (challenging and conflict resolution if necessary)

– Public Health Education

– Promotion of individualised, woman-centred, holistic care

• Different motivations, influences and rationale behind decision-making:

– Fiona

– Fiona’s family

– Midwife

– MDT – obstetrician, paediatrician, anaesthetist

• Midwife’s Role

– Listen: non-judgemental, caring

– Acknowledge: don’t just dismiss fears or make decision for her

– Reassure: Fiona’s decision, can discuss any time, not a decision she must make now / on her own, can change her mind as pregnancy evolves, midwife’s support / advocacy whatever her decision

– Identify: what are the individual family / social / obstetric circumstances for this particular woman?

– Assess: mental and emotional wellbeing – referral to e.g. counselling?

– Assist: highlight information regarding VBAC v. planned CS; referral to e.g. Consultant Midwife / Obstetrician / Birth Choices Clinic; signposting to useful factual resources

– Recording: Document all discussions, conversations in MHHR. Must keep Fiona included in / updated on decision-making process.

Breastfeeding Scenario

• BF in context

– Benefits, risks, challenges

– Research (e.g. statistics around BF compliance / cessation rates)

– Professional guidance (e.g. NICE, UNICEF-UK BFI, RCM)

– Alternatives: assist to BF again now / hand express / top-up / change to formula feeding

• Range of professional issues and obligations linked to shared decision-making, including:

– Advocacy

– Communication with woman and MDT (challenging and conflict resolution if necessary)

– Public Health Education

– Promotion of individualised, woman-centred, holistic care

• Different motivations, influences and rationale behind decision-making:

– Hanna

– Hanna’s family

– Midwife

– MDT – paediatrician, Infant Feeding Specialist

• Midwife’s Role

– Listen: non-judgemental, caring

– Acknowledge: don’t just dismiss anxieties or make decision for her

– Reassure: Hanna’s decision, can discuss any time, not an irreversible decision she must make right now, can change her mind as PN experience evolves, midwife’s support / advocacy whatever her decision

– Identify: what are the individual family / social / obstetric circumstances for this particular woman?

– Assess: mental and emotional wellbeing, desire and motivation for BF

– Assist: facilitate Hanna’s choice (help with BF / HE / top up); signposting to useful factual resources, advice and support groups

– Recording: Document all discussions and decisions in MHHR.