Appreciative Inquiry Used in Specialist Midwifery Education to Strengthen Human Rights Based Approach

Purpose:

Advanced Midwifery and Neonatology is offered as a Post-Basic qualification and aims to equip midwives with competencies in all the roles of a specialist midwife. Roles that they are prepared for include that of a leader, change agent, manager, clinician and educator. The programme is embedded in the International Confederation of Midwives (ICM) Philosophy and Model of care in concepts like partnership and respect. The relationship and work of the midwife is based on a partnership relationship that is embedded in the human rights based approach to care. In a meta-syntheses reviewed for the Lancet Midwifery series it was confirmed that women desire respectful, clinically competent care with good communication, and the value of partnership expressed as having a sense of control, and the ability to participate in their care and make choices. The relationship should be respect their cultural and personal needs (Sakala & Newburn, 2014)

Sadly this is not the reality in practice. Safe motherhood as a human right is the point of departure and at the end of the year they need to again find the voice for ensuring respect for human rights and the ability to change practice going back to the institutions that sent them for the course (Human rights watch, 2011).

Methods:

A Technical Guide Principle of Human Right Based approach was developed as a multinational project.  A two day workshop with educators on the principles of human right based approach to kick start the process was conducted. After this workshop an Appreciative Inquiry (AI) workshop was developed and implemented with the students. The aim was to empower them to act as change agents to implement the human based rights approach and ICM Philosophy and Model of care, and translates that into everyday practice, whilst collecting qualitative data on the human rights based appraoch( HRBA).

AI is a strengths-based approach to change management that uses four or five steps to draw on existing strengths in an organization /group to enable them to implement change.

The workshop run over one day with guided refection and tasks within four steps. A comprehensive workshop document was developed and every student gave written consent to take part in the workshop as well as for dissemination of information from the workshop.

Results:

The first AI step was DISCOVERY. During this the participants who were seated in 5 groups, split in pairs of two and asked each other the questions in this phase. They collated their responses in a shared session at the tables. The questions evolved around successes based on their exposure to HBRA in Maternal Neonatal Child and Reproductive Health (MNCRH). Positive themes of the HRBA in MNCRH were identified and through a Nominal Group Teqnique the group reached consensus on the most important factors to address.

The second step was DREAMING, when the excellence that was mentioned during the discovery and invited is taken further. Participants were asked to define their contribution to an excellent midwifery team in a period four years from now. Groups made collages to portray this dreams.

The third step involves the DESIGN of a positive proposition of each group. These single line statements are co-created by group members and described their HBRA to care. The theoretical base of Social Constructionism where the contributions of the individual participants shapes new behavior shapes this step.

Lastly the group formulated their DESTINY.  This is a session that will guide them how to get to this destiny. Actions and ideas that would operationalize the HBRA are written down. One participant wrote: ‘I am taking accountability to bring change, to do good to the women.” Another wrote:” Speak up and do the right thing.”

Conclusion:

All the students reflected positively on their participation in this workshop during the course evaluations. The impact of a HBR focus on care did touch them to improve the competence of care for families seeking MNCRH care. The value of HBRA in midwifery education should be communicated and programmes should include this focus in their content.AI as qualitative research method provided both rich data but the process empowered students to take up the role of change agent.