Learning and teaching in the context of clinical practice: the midwife as role model.

Abstract

The purpose of this study was to develop a theory in order to explain the meaning and process of learning the role of the midwife from midwives in the clinical setting. To achieve the depth and detail required in the absence of literature on this topic, the grounded theory approach was adopted. The sample consisted of twenty student midwives and seventeen midwives. Data were collected by means of unstructured interviews which were tape-recorded. Each participant was interviewed on a minimum of two separate occasions. The constant comparative method was used to analyse the data. The findings of the research contribute to knowledge by making explicit how the role of the midwife is interpreted and enacted, the effect this has on what role students learn, how it is learned and hence how the role is transmitted from one generation of midwives to the next. The `emic' perspective facilitated the emergence of a number of theoretical ideas. Central to these are the rules of practice. When midwives rigidly follow written and unwritten rules they prescribe midwifery care which corresponds to the medical model. In doing so they act as obstetric nurses or handmaidens to the doctor. When everything is interpreted as rules to be followed prescriptive midwives appear to be uncaring and detached from the experience of childbirth. The individual needs of women are not met and the relationship between midwife and client is superficial. Midwives who rigidly follow the rules inhibit the growth and development of students providing them with few opportunities to achieve beyond the level of their role model. Midwives are flexible when they interpret the rules for the benefit of women and provide a woman-centred model of care. These midwives therefore act as autonomous practitioners. When rules are interpreted and adapted to meet the needs of women, flexible midwives demonstrate involvement in women's experiences and are empathic, supportive and caring. Midwives who use professional judgement to interpret the rules provide an environment in which senior students can become autonomous practitioners. When midwives demonstrate the role of autonomous practitioner, practise a woman-centred model of care and meet the learning needs of students, they are appropriate role models and teachers. There is conflict in the clinical setting when practitioners who hold opposing attitudes, values and beliefs practice together. Conflict can be avoided when flexible midwives adopt strategies that involve becoming prescriptive or practising by subterfuge. In accordance with Bandura's social learning theory students learn by observing and emulating the example of their role models. Learning is vicarious when students observe the consequences of their role models' actions. When learning the role from a role model is interpreted as a passive process, a behaviourist and pedagogical approach to learning and teaching ensures perpetuation of the obstetric nurse role that is no longer considered acceptable. Role modelling serves as a vehicle for transmitting new behaviour when learning is perceived to be an active process. In this case a humanistic, andragogical and cognitive approach to learning and teaching is adopted giving students the freedom to determine their own role. Practice from a number of role models is emulated. In this way each midwife acquires a unique identity which is derived from an abstract role model rather than a particular person. Students are prepared for the autonomous role of the midwife, and it is this role they wish to emulate.