Decision‐Making Theories and their usefulness to the midwifery profession both in terms of midwifery practice and the education of midwives

Abstract

Jefford E, Fahy K, Sundin D. International Journal of Nursing Practice 2011; 17: 246–253 Decision‐Making Theories and their usefulness to the midwifery profession both in terms of midwifery practice and the education of midwives What are the strengths and limitations of existing Decision‐Making Theories as a basis for guiding best practice clinical decision‐making within a framework of midwifery philosophy? Each theory is compared in relation with how well they provide a teachable framework for midwifery clinical reasoning that is consistent with midwifery philosophy. Hypothetico‐Deductive Theory, from which medical clinical reasoning is based; intuitive decision‐making; Dual Processing Theory; The International Confederation of Midwives Clinical Decision‐Making Framework; Australian Nursing and Midwifery Council Midwifery Practice Decisions Flowchart and Midwifery Practice. Best practice midwifery clinical Decision‐Making Theory needs to give guidance about: (i) effective use of cognitive reasoning processes; (ii) how to include contextual and emotional factors; (iii) how to include the interests of the baby as an integral part of the woman; (iv) decision‐making in partnership with woman; and (v) how to recognize/respond to clinical situations outside the midwife's legal/personal scope of practice. No existing Decision‐Making Theory meets the needs of midwifery. Medical clinical reasoning has a good contribution to make in terms of cognitive reasoning processes. Two limitations of medical clinical reasoning are its reductionistic focus and privileging of reason to the exclusion of emotional and contextual factors. Hypothetico‐deductive clinical reasoning is a necessary but insufficient condition for best practice clinical decision‐making in midwifery.

Critical thinking in midwifery practice: A conceptual model

“…Using an analytical or rational approach, this clinical information combined with the evidence, is often used to inform decision making. In contrast to other health disciplines, midwifery care is philosophically grounded within a primary healthcare model where pregnancy and birth are viewed as normal, physiological life events (International Confederation of Midwives [ICM], 2014; Jefford et al, 2011). Holistic decision making is required which incorporates diverse ways of knowing whilst valuing the significance of birth and becoming a mother (Siddiqui, 2005).…”

“…The role of the midwife is distinctive, multidimensional and complex, requiring highly developed clinical and cognitive skills. Midwives require well developed critical thinking skills to inform professional judgement that is evidence based, safe, woman-centred and individualised (Mènage, 2016;Jefford, et al, 2011). Critical thinking, a human cognitive process entailing focused thinking that is self-regulated and promotes development of knowledge to informing clinical judgement and decision making (Facione and Facione, 1996).…”

Cue acquisition: A feature of Malawian midwives decision making process to support normality during the first stage of labour

“…One such theory, the information processing theory, suggests a four-staged linear, logical and rational process. This involves cue acquisition, hypothesis generation, data interpretation, and hypothesis testing (Jefford et al, 2011). The theory provides explicit and systematic approaches to decision making.…”

“…The theory provides explicit and systematic approaches to decision making. In addition, the steps can be tested, taught and provide a consensual decision to be made that is justified by data (Standing, 2010;Jefford et al, 2011). However, these linear steps may not reflect the iterative nature of the processes that midwives use during decision making in the 'real world' setting.…”

Conceptualising An Approach To Clinical Reasoning In The Education Profession

“…Expert teachers intuitively decide to take a course of action-their practice is non-rule governed and uses intuition (Benner, Tanner, & Chesla, 2009), involving the recognition of pattern, similarity, salience and deliberate rational thought (Jefford, Fahy, & Sundin, 2011). Conversely, novices work on a set of rigid and clearly articulated rules (Dreyfus & Dreyfus, 1986).…”