Decision-making between nurse-midwives and clients regarding the formulation of a birth plan
This descriptive qualitative study examined the interaction between nurse-midwives and clients during prenatal visits in the third trimester as they formulated a birth plan. The study was concerned with decision-making and the participative behaviors exhibited by the participants while engaged in the process. ^ The theoretical framework undergirding the study was Kim's (1983b, 1987b) theory of collaborative decision-making in nursing practice. This field study was conducted using the participant observation approach of Schatzman and Strauss (1973) and the analytic ethnography perspective of Lofland (1995). ^ Data consisted of twenty audiotaped prenatal visits between CNMs and clients with accompanying field notes and forty post-visit telephone interviews with CNMs, and clients separately. Audiotapes of the visits and interviews were transcribed verbatim. ^ Qualitative data were analyzed by content analysis with the aid of the Ethnograph computer program. Three distinct patterns of interaction emerged from the data and were supported by CNM and client behaviors. The pattern of directives was shaped by the CNMs perspective and ideas about what topics should be included in a birth plan. The CNM was directive, “in control”, and took a proactive stance for completing a birth plan. The pattern of emergence was characterized by the ultimate flexibility of the CNM in addressing a particular topic or issue of concern to the client. In this pattern, a birth plan was at a beginning stage of development. The pattern of validation involved the mutual participation of the CNM and client reviewing a completed birth plan. Processes of elaboration, support, clarification, and agreement were evident. ^ This study was important for a variety of reasons. First, there was no prior research examining CNM-client interaction with regard to decision-making in formulating a birth plan. Yet, studies are needed that link CNM-client communication patterns to outcomes. Second, the study proved that Kim's (1983b, 1987b) theory has utility for understanding and explaining CNM-client encounters in a prenatal setting. Third, findings suggested that the manner in which CNMs approach a birth plan with clients has important implications for future practice. Fourth, the knowledge generated concerning CNM-client interaction, collaboration, and decision-making suggest applicability across the entire spectrum of nursing—involving all types of client-health care provider encounters. ^
Health Sciences, Obstetrics and Gynecology|Health Sciences, Nursing
Doherty Mary Ellen,
"Decision-making between nurse-midwives and clients regarding the formulation of a birth plan"
Dissertations and Master's Theses (Campus Access).