Using a consensus method towards the promotion of professional conduct in midwifery in South Africa

Abstract

Aim The aim was to obtain consensus on how professional conduct can be improved in midwifery. Background Although a decrease in maternal mortality is seen in South Africa, it is still unacceptably high in comparison with first world countries. The aim is to reduce maternal deaths to 100 per 100 000 deaths by 2030. The role of midwives in the care of mothers and babies has been recognised worldwide and therefore they also play a crucial role in the reduction of maternal deaths. Programmes have been rolled out to ensure that midwives are skilled and knowledgeable. However, it seems that professional conduct is a contributing factor in maternal mortality and needs to be improved in order to reduce maternal death. Therefore, the goal of the study was to reach consensus on how professional conduct can be improved. Methods The methodology utilised was a consensus method, namely the nominal group technique. The question was asked; “How can professional conduct be improved in South Africa?” Three nominal group sessions were scheduled consisting of midwives of different age groups, and years of experience working in any context of midwifery care in South Africa. Thirteen midwives participated and generated 19 themes that were finally put into two main themes. Data collection and analysis were done simultaneous. Findings Two main themes emerged: Basic education and training and work environment. Basic education remains a high priority, but needs to include more aspects focused on interpersonal skill, such as communication, stress management, team work, compassion, attitude and leadership. It also needs to focus on a selection process that evaluates character to ensure that the most suitable candidates are selected. The work environment also plays a significant role in the professional conduct of midwives. Excessive workload, lack of staff, poor work environment and limited support from management are some of the aspects that make it difficult for a midwife to be kept accountable. This difficult work environment causes feelings of stress and guilt and corrodes the motivation and work satisfaction of midwives. Furthermore, conflict between what is expected of a midwife in a professional sense and what is allowed in practice causes confusion, specifically in newly qualified midwives. In hospital settings the practice is task-orientated and doctor-centred, moving away from a professionalism that is autonomous and allows for decisions to be made on needs and care of patients. Often company values will differ from the midwife’s focus on patient-centred, individualised care to a bigger focus on productivity and financial efficiency. Conclusion The recommendations made focused on education, clinical practice and research development. Apart from the already existing curriculum that includes professional practice, it is important to include extensive modules on the development of interpersonal skills such as communication, team work, stress management and leadership. Clinical mentors are needed to guide students and demonstrate ethical principles and interpersonal skills. Recommendations for clinical practice include the improvement of clinical facilities with sufficient stock and equipment so that students can learn, but also for the best care of patients. To create a culture of excellence, practice must ensure clear guidelines on responsibility, well established processes for accountability and an environment that allows midwives to render safe and compassionate care.