An ethnographic exploration of labour ward midwives’ accessing and using of information for practice.
Aims: This study is an ethnographic exploration of how midwives access and use information whilst giving care in the high risk labour ward. The study explores midwives’ identification of their information needs, what sources and types of information midwives use, how midwives use information and what facilitates and inhibits information access.
Background:
Medical, surgical, pregnancy or emergency conditions existing or developing through pregnancy with the recommendation that care and or birth takes place under direct obstetric care rather than midwifery led care is termed high risk. Despite being obstetric led, midwives, as members of the multidisciplinary team, have a key role in delivering care for women in the high risk category. The diversity of potential conditions are broad, some occur frequently, others happen infrequently and unexpectedly. Midwives delivering high risk care to women are likely to access and use information during their care.
Care quality benchmarking (Department of Health 2010, 2009, 2008, 2007, 2003, 2001, 2000, 1997) the increasing number of women with high risk needs using maternity services (National Institute for Health and Clinical Excellence (NICE) 2012, Kings Fund 2008, Botting and Dunnell 2003) and professional standards (Nursing and Midwifery Council 2012, 2008) indicate that individual midwives are now under increasing pressure to perform to a high standard. As the volume of information available to midwives is increasing exponentially (Wyatt and Sullivan 2005, Sensky 2002, Smith 1996), this suggests that midwives need to access information to deliver excellent care to women (Thomas and Dixon 2012).
The labour ward context and working environment may affect how midwives behave during practice when accessing and using information. If standards of care are to be maintained and improved by midwives, an understanding of how they use information at the point of care will give a foundation to developing reliable evidence sources in a format that they readily use. The behaviour of midwives in the labour ward environment will show how midwives access and use information during care.
Information behaviour is the overarching term for searching for information; it is defined as the ‘totality of human behaviour in relation to sources and channels of information’ (Wilson 2000: 49). Wilson (2000) suggests that information behaviour research is of value to scientists to enable effectiveness in seeking, searching and using information. In healthcare, information behaviour has been studied to guide and promote effective database searching techniques (McKnight 2006) and library searching (McKnight 2007). There is no direct evidence about information behaviour of midwives, suggesting that it has not yet been explored or that midwives know the answers to their practice questions although studies to this effect have not been found.
Methods and Analysis:
The behaviour of individual midwives is the focus of the study, however, midwives’ behaviour is part of the larger group of midwives working in the labour ward, who in turn, are a component of the labour ward environment, including other staff, workloads, time frames, emergencies, equipment, management, administration and women being cared for. Therefore, ethnographic observation and interview is used. Data was analysed using thematic analysis. The findings will be available when the thesis is complete.
Twenty one purposively sampled midwives providing high risk labour ward care were observed for up to 3 hours. One midwife was observed on three different occasions. One midwife self nominated for observation. All provided written consent. Each midwife was allocated a pseudonym. Ten of these midwives were subsequently interviewed using a semi-structured format which included general questions about how information is accessed and used. During 90 hours spent on the labour ward, 49.5 hours of direct observation was collected and recorded directly onto a netbook.
Every midwife who was interviewed was given the opportunity to read their interview transcriptions, only six took up the offer. None of the midwives raised queries after receiving their transcriptions.
The women in the midwives’ care were given ethically approved information about the study and were verbally consented. Aspects of the care being provided to the woman and their current diagnosis and treatment were recorded. No identifiable information was recorded about the woman.
Favourable ethical opinion was given by Oxford C Research Ethics Committee in July 2011.
Ethnographic analysis was conducted according to a composite of several frameworks (Strauss and Corbin 1990, Emerson et al 1995, Scott Jones and Watt 2010). The 49.5 hours of direct observation were transcribed at the point of collection and generated 254 pages of double line spaced data. The ten interviews with midwives were transcribed after collection and generated 281 pages of double line spaced data. Observational and interview data were coded together for a seamless approach and depth of findings. Open coding was the indiscriminate examination of all parts of the data. This generated 5700 codes throughout the process rather than the application of pre-ordained codes. These were then grouped in 356 sub themes and 47 themes. I then carried out focussed coding by applying the research questions to the data as I coded, generating 46 sub themes. Subsequently I produced integrative memos according to the principles of Emerson et al (1995). Findings have been written up for the final thesis.
Project finish:
This study explores the information behaviour of midwives in the labour ward environment as an understanding of how midwives access and use information may give valuable insight into the most effective and usable form of information for practice. When the thesis is complete the findings will be appropriately disseminated via publication and conference to the wider midwifery community in 2014 and 2015. Recommendations for practice and for future research will be made at this time along with implementation plans for clinical practice.