Supporting midwives to develop and reflect has always been an important aspect of practice. Understanding safeguarding principles is significant for maintaining a healthy workforce. In this article Gaynor Morrison, Specialist Midwife in Safeguarding and Lecturer at Surrey University, and Sharon Bunford, Named Midwife for Safeguarding and Professional Midwifery Advocate, Royal Surrey County Hospital NHS trust, discuss Safeguarding Supervision within midwifery.
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The purpose of this article is to explore and reflect on some of the values of Safeguarding Supervision within midwifery.
Safeguarding Supervision has a long history with social care practice and has been embedded within those organisations and in more recent times, introduced to acute NHS trusts. It has been identified as having four main functions and in early findings these were defined as management, support and development (Kadushin,1976) and in later years a fourth was added by Richards et al (1990) as mediation. These four dimensions are the underpinning of supervision and are integral to the definition. Harries (1987):
‘Supervision is a process by which one worker is given responsibility by the organisation to work with another worker(s) in order to meet certain organisational, professional and personal objectives which together promote the best outcomes for service users’.
Safeguarding Supervision within health and in maternity settings has been adapted from this framework and we recognise that most of the literature is derived from social care and there is a limited resource of findings within midwifery literature.
This primary aim has been underpinned by a report from The Kings Fund (2020), a charity whose aims are to improve health and care in England. Their recent study by West, Baily and Williams (2020) focussed on how best to support midwives to ensure they deliver high quality care. They produced a framework and identified 3 main areas that need to be achieved in order to maintain a healthy workforce. They define these areas as the A, B, C of core work-based needs which stand for Autonomy, Belonging and Contribution.
- Autonomy – ‘to act consistently with our work life values’ – to gain greater understanding of our own core values and beliefs so that we can make intuitive and safe decisions in complex and vulnerable family cases. For the midwife to prioritise their statutory learning and assessment and to be able to reflect on these cases within the Safeguarding Supervision provision.
- Belonging – ‘the need to be connected to, cared for, and caring of others around us in the workplace, and to feel valued, respected and supported’ to utilise the ‘open door’ philosophy of the Safeguarding Midwifery Team and feel listened to and heard when faced with challenging situations and to never work alone. (DoH: Working Together, 2018); Children’s Act (2004); Social Work Act, (2017).
- Contribution – the need to experience effectiveness in what we do and deliver valued outcomes, such as high-quality care (Stone et al 2009). Midwives should be involved and develop their understanding in writing robust plans of care for babies on Child Protection Plans whilst maintaining a child centred approach (DoH, 2018). The midwife will also reflect on their practice to ensure safe, high-quality care has a plan in place to be achieved.
Stone et al (2009) recommend that when all three of these needs are met, the evidence suggests that people are more intrinsically motivated, engaged and have better health and wellbeing within themselves, leading to enhanced performance, persistence and creativity. However, Ryan and Deci (2000) argue that if any one of these needs is not met, then wellbeing, motivation and performance suffer which can be at huge cost to not only the Trust but to the midwifery profession and the families they care for.
Whilst the NMC’s work around ‘Why midwives leave’ revisited in 2023 does not identify ‘Safeguarding’ as a reason why midwives leave reasons include; too much pressure, poor workplace culture increased workloads and a lack of staff, complexity of cases, stress, lack of support and the feeling of not having done enough are contributory factors. Barker (2016) acknowledges these findings and in her recent audit the results were static. She recognises that a culture that leads, supports and builds confidence is vital for new midwives to feel valued and to stay. Supervision provides an opportunity for organisations to support midwives with these challenges by providing a reflective space to analyse and process these stresses. It also provides a safety net for practitioners enabling them to review clinical practice and make changes where necessary. This is of extra value as our midwifery model of care focuses less on care in the home environment, and more towards care in midwifery hubs and clinics. Safeguarding Supervision is crucial in providing support and enhancing safeguarding skills for staff who may be less familiar with providing care in a home setting for families with complex needs.
Safeguarding supervision can be offered in the clinical areas of Maternity via one-to-one unplanned responsive sessions or prearranged scheduled times such as during team meetings. Wonacott (2015) has raised concerns around the quality of safeguarding supervision in health care settings especially in its early implementation, however, as her published work informs her training package, which is offered to health care professionals, it could be argued that she has a conflict of interest in highlighting the need for quality training. Good Safeguarding Supervision does demand time and resources for the preceptee to prepare a case study, find a confidential area and use a Safeguarding tool plus; they must use their own case load reflections to draw upon to make full value of the session as it can be the cornerstone of safe practice (Laming, 2003).
Midwives within the authors Trust use an andragogy learning model devised by Kolb (1984) to enable them to transform safeguarding experiences into reflection. This can be triggered when the Supervisor asks the preceptee to review a case study (Wonnacot, 2015) or by the preceptee discussing a case as part of the referral process in clinical practice. The midwife must be engaged with the experience and be able to learn from it. There are arguments for and against for both types of formal and informal supervision and it is the role of the Supervisor to be aware of the advantages and disadvantages (Morrison, 2005). The midwife/learner needs to reach their own solution, the facilitator must be self-aware and demonstrate emotional intelligence (Mayer and Salovey, 1997) regarding the case scenario that they are discussing and be mindful not to try and ‘fix’ or provide the answers leading the learner to reach their own ‘Aha’ moment.
Reflective supervision is multi-layered and Ruch (2000) identifies four levels of reflection which are defined as technical, practical, process and critical. Supervision enables the preceptee to navigate through the Supervision cycle and encompass these four layers of reflection. As clinicians it can be argued that midwives may get stuck in one element such as technical – did I follow the right policy or pathway with that client issue? or perhaps critical reflection – where they focus on their own emotions or values. Using Schon’s (1983) reflection on action allows the preceptee to step back from the scenario or case and create space so that the Supervision cycle can be used as a whole and engage with thoughts, feelings and actions.
This type of reflection has dual purpose and can also be used as a reflective account in the midwives’ tri annual NMC (2018) revalidation. It relates to the Code of Practice (2018) public protection and can give evidence of how the midwife has prioritised people, practiced effectively, preserves safety or promotes professionalism and trust depending on the case and their involvement. A challenge for midwives is creating or ring fencing the time to complete this in a clinical working day. The facilitator needs to help manage these issues and must consider the safety of the unit before progressing in the group Supervision session as this should be in confidence and undisturbed once started (Wonnacott, 2015). Each organisation will have their own solution to these issues. In the authors experience it can be helpful to bring supervision to the midwife, either through the facilitator attending already planned team meetings or perhaps as part of the professional midwifery advocate (PMA) interactions.
We recognise that safeguarding supervision is required in the workplace and contributes to midwives feeling safe, valued and heard.
Gaynor Morrison MSc, BSc (hons) : Specialist Midwife in Safeguarding and Lecturer at Surrey University.
Sharon Bunford MSc, BSc (hons) : Named Midwife for Safeguarding. Royal Surrey County Hospital NHS trust
October 2023
References
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