An exploration of clinical decision-making among students and newly qualified midwives.

OBJECTIVE

to explore how midwifery students and newly qualified midwives learnt to make clinical decisions.

DESIGN

an ethnographic approach was taken. Data collection methods included: 3 focus groups, 15 observations of practice and 27 interviews. The data analysis followed the principles of category and theme identification as described by Garner (1991) and Ely et al. (1997). Vignettes were created to represent the findings.

SETTINGS AND PARTICIPANTS

the study took place in the School of Nursing Sciences and 2 NHS Trusts in the Eastern region of England. Participants included 36 midwifery students, 5 midwives who had been qualified for less than 1 year and 12 midwifery mentors.

KEY CONCLUSIONS

decision-making was learnt primarily by working alongside midwifery mentors and through situated learning in practice. Decision-making was not necessarily a solo activity, it was common for midwives to use each other as a resource, which established there was a social dimension to midwifery decision-making. Learners had to navigate through workplace culture, which consisted of: the practices shared by some midwives and not others, covert rules of practice, midwifery and institutional authoritarianism.

IMPLICATIONS FOR PRACTICE

learners need to work with mentors who actively encourage participation in decision-making and provide discussion and feedback on decision-making abilities. When a staged and active approach to decision-making is not provided this may have negative implications on the transition to qualified practitioner.