Theoretical Foundations for Nursing Roles and Practice

Woman-centered care in childbirth is the process in which a woman can make choices, be involved in, and has control over her care and relationship with her physician or midwife (Maputle & Donavon, 2013). Woman-centered care is a philosophy of care which gives priority to the wishes and needs of the female patient during labor, to improve the women’s ability to make informed choices about many aspects of their care and birthing process. The aim of concept analysis is to clarify meanings of similarity and identify multiple considerations for measuring the concept (McEwen & Willis, 2011 p. 4).

Concept clarification is an important step in developing fundamental principles of useful and usable knowledge in childbirth. The aim of this article was to study the concept of woman-centered care through analysis in the context of childbirth to ensure women are equal partners in the planning and delivery of their childbirth experience and care. The study was to conduct concept analysis of woman-centered childbirth care in order to clarify meanings of similarity and identify multiple considerations for measuring the concept (Maputle & Donavon, 2013).

The research question addressed in this article is: What is the meaning of woman-centered care in childbirth? The attributes, and consequences of this concept are identified, and a model case, a borderline case and a contrary case constructed to achieve conceptual clarity (Maputle & Donavon, 2013). A concept analysis was performed as described by Walker and Avant, with an extensive research of specific literature and evidence from various disciplines. Methods of Analysis Concept analysis is used to examine and describe a concept and its application.

The objective is to clarify the meaning of terms and to define the concepts so a common language about the concept is understood (McEwen & Willis, 2011 p. 54). The concept should be clear and distinct, unambiguously defined and well differentiated from other concepts, and should be applicable to the world and appropriate in context. Concept analysis is applied for the refinement and definition of concepts originating from nursing practice, nursing research and nursing theory (Maputle & Donavon, 2013), which helps to differentiate between similar and dissimilar concepts.

Walker and Avant assert that concept analysis and development are fundamental processes required by nurse researchers who are attempting to measure the metaphysical phenomena of nursing, or in this study the midwifery practice. The framework suggested by Walker and Avant was used for the analysis described in this research. The method of research included: • Selection of the concept • Specification of the aims of analysis • Identification of uses, characteristics of the concept • Determination and definition of attributes Development of model cases which exemplify the analysis • Identification of antecedents and consequences • Definition of empirical referents (McEwen & Willis, 2011 p. 54)

A study ‘Experiences of childbirth by mothers at the tertiary hospital in Limpopo Province’ was conducted (Maputle & Nolte 2008), and experiences of the mothers during childbirth revealed the major concept ‘woman-centered care’. ‘Woman-centered care’ emerged as a core concept because it was found to be the central idea or event, and all the other categories and attributes were contingent upon it.

The concept was also relevant to childbirth care within the framework of the Batho Pele principles directed at a customer-focused approach. An extensive literature search of computerized databases and manual searches of online journals were also undertaken to ensure that characteristics associated with the concept of woman-centered care were included in the search terms. Literature-based analysis included specific disciplines, for example nursing, medicine, humanities and nursing management.

Process Steps and Results Standardized routines can also be viewed as part of the biomedical odel, which has a dominant effect on health care as it serves mainly the relevance of midwives to their public roles during childbirth. The biomedical model is characterized by a concentration of information and decision-making in the hands of doctors and midwives, and to a lesser extent in those of women. The emphasis of the model is more on high technology, which leads to the loss of basic human care. Women are labeled according to their diagnoses, rather than being recognized as patients with needs that call for appropriate attention and responsiveness.

Nevertheless, Pearson et al. (1998:37) affirm that the biomedical model is well developed and undoubtedly gives indispensable direction to midwifery practice. Application of Concept to a Practice Situation Hospitals that provide childbirth care frequently prescribe routines which are adhered to due large in part by their policies and procedures. Physicians and Midwives generally feel that it is their responsibility to ensure those policies and procedures are adhered to. It is indicated that the end result of following procedure is a robotic way for maternal care during childbirth.

These policies and procedure lead on to the expectation that the mothers must comply with a these “rules” and follow the routine which is not a women-centered approach to care. Adherence to such standardized policies may have substantial benefit, but this also depersonalizes mothers experience and discourages her full participation and involvement during her maternal care. In terms of practice, it was recommended that the reference of ‘woman-centered care’ be integrated into childbirth care and practice to measure the concept.

When the empirical referents of the concept are understood, mutual participation during childbirth will be enhanced. With regard to implications for theory development, it was recommended that a model of ‘woman-centered care’ in childbirth be developed based on the results of the concept analysis. For nursing education, the empirical concept analysis would assist learners to acquire an interactive constructing process followed by consolidation of knowledge, creating new insights for critical thinking. Concept analysis is a part of knowledge development.

Clarified concepts may be applied to obstetric and idwifery situations. They provide an insight into problems which, in turn, motivate further analyses. Challenges in the care of childbirth gave rise to the use of ‘woman-centered care’ in order to provide and promote participation between physician and midwife of women during childbirth. This concept would cultivate mutual participation, and respectful relationship. There would be partnership and collaboration in decision-making between the physician or midwife and a woman during childbirth, which will benefit and have a positive impact on childbirth and the experience.