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A critical analysis of a tripartite clinical decision involving a student, midwife and client

02 December 2022
Volume 30 · Issue 12



Clinical decision-making is integral to contemporary healthcare. Midwives support and advocate for primarily healthy women throughout a life-altering transition, as set out in the code. They provide safe, evidence-based, compassionate and individualised care in partnership with women, to promote choice and shared decision-making. This critical reflection analyses a tripartite clinical decision, focusing on the hypothetico-deductive and dual processing models. This is an opportune time to reflect upon one's own practice, particularly in light of the Ockenden report, to ensure high professional standards are maintained collaboratively across all parties involved in a clinical decision.

Clinical decision making is an integral part of healthcare today. However, clinical decision making within the midwifery profession differs from many other areas in healthcare (Ockenden, 2020). Midwives support and advocate for primarily healthy women throughout a life-altering transition. They are upheld to a professional standard represented by the UK Nursing and Midwifery Council (NMC, 2018) code to provide safe, evidence-based, compassionate and individualised care in partnership with women, promoting choice and shared decision-making (Ménage, 2016; National Institute for Health and Care Excellence (NICE), 2019). Midwives are responsible for the care of the woman and her baby, more commonly known as the woman—baby dyad. The Association for Improvements in the Maternity Services (2012) believe this is crucial for the health of women and their families.

Clinical decision making is not static, and recommendations for best practice are continuously changing as innovative research and investigations provide up-to-date evidence to enable practitioners to give individualised care and minimise perinatal morbidity and mortality. Reports such as Ockenden (2022) provide thought-provoking case studies that enable midwives to reflect on their own practice cases, to learn from their mistakes and strengths, and change how they approach clinical decision making for individual clinical scenarios to improve outcomes for women and their babies. The critical reflection presented in this article reviews the clinical decision making process within a personal midwifery case-decision, focusing on the hypothetico-deductive and dual processing models involving a midwife, student midwife and woman, Lucy (pseudonym) (Elstein and Schwarz, 2002; Jefford et al, 2011; Kahneman, 2011).

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