Caring for women: the potential contribution of formal theory to midwiferypractice

Objective: to explore the interpretations midwives and nurses attach to the concept of caring, how caring values are manifest clinically and might be encouraged educationally. Design: ethnographic fieldwork was undertaken in UK National Health Service palliative and maternity-care hospital settings for 12 and 10 days respect ively. This involved non-participant observation, semi-structured, audio-ta ped interviews with seven midwives and six nurses. Ad hoc conversations wit h service-users were also undertaken and contextual information, such as st affing levels, was collected,The data were thematically analysed against a conceptualisation of caring developed from nursing and philosophical litera ture. Findings: comparison of observational and interview data across the setting s identified qualitative differences in care delivery. In the palliative ca re setting, practice was other-centred, receptive, responsive and attentive to the patient's person and experience. In comparison, caring values appea red eroded in the maternity setting, where practice was often routinised, t ask-orientated and, on occasions, unresponsive to women's needs. Features e xisted in the palliative care setting which appeared instrumental in facili tating a caring practice culture. In particular, clinical leaders facilitat ed team cohesion through daily 'debrief' meetings and care enhancement agai nst theoretical frameworks. These encompassed caring values and provided th e source of problem identification and remedial strategy. No such collectiv e, theoretical perspectives were evident in the maternity setting. Discussion and implications for practice: whilst acknowledging the limitati ons of formal theory, it is suggested that midwifery goals and priorities o f care could be utilised to theoretically frame, critically evaluate and gu ide practice. This has the potential to heighten awareness of care deficits and enable midwives to work collectively to enhance women's experience of childbirth at both clinical and political levels. (C) 2000 Harcourt Publish ers Ltd.