Accepted Type
Oral
Code
OG2-2-4
Was this work accepted for CCME 2020?
yes
Category
General Call (Workshop, Oral Presentation, Poster Presentation)
Type
Oral
Sub Type
Education Research
Will the presenter be a:
Student
Affiliation
Considered for Poster
yes
Title
There's got to be a better way: Institutional Ethnography of intrapartum practices on a Labour & Delivery unit
Length of Presentation
Background/Purpose
Labour and delivery (L&D) units can be contested workplaces with tensions between obstetrician,
nursing, and midwifery practices. These tensions can impede communication and raise patient safety
concerns. Remedying such tensions requires study of the driving forces contributing to these
recurrent problems in interprofessional practices.
Methods
Our institutional ethnography study initially used critical incident analysis reports to identify
recurrent issues related to transfers of care (TOC) and consultation requests between midwives and
obstetricians. We then mapped the work of midwives, nurses, family physicians, and obstetricians by
observing (75 hours) and interviewing them (n=15). We also traced work processes to local (forms
and hospital policies) and external texts (national policies and evidence-based guidelines). Final
analysis made visible the otherwise hidden links between everyday work of L&D practitioners and
higher-level coordinators.
Results
We identified three work processes involving midwives consulting obstetricians: induction with TOC
back to midwife, consultation without TOC, and TOC. Three points of disjuncture complicated these
processes: a local "3 consult rule", linked to higher-level medical-legal governance and remuneration
structures; subjective interpretations of the "4cm dilation rule", a policy meant to standardize
practice; and regulations that delayed timing of consultations.
Conclusion
Our study extends existing research demonstrating that medicine-driven governance of midwifery
practices can perpetuate interprofessional challenges. For example, the "3 consult rule" was
established for patient safety purposes, but in practice can actually function to delay and disrupt
work processes, potentially compromising patient safety. While practitioners spoke of the three
points of disjuncture as 'laws', most also viewed them as ostensibly modifiable.
Keyword 1
Institutional ethnography
Keyword 2
Labour & Delivery
Keyword 3
Intrapartum Care
Level of Training
General
Abstract Themes
Inter-professional Education
Additional Theme (First choice)
Patient Safety
Additional Theme (Second Choice)
Continuing Medical Education
Additional Theme (Third Choice)
Faculty Development
Authors
Presenter
Lori Nemoy
Term 1
Yes
Term 2
Yes
Term 3
Yes
Term 4
Yes
Term 5
Yes
