Research into EPRs: how midwives really feel.

This article describes some of the findings of a two-year research project entitled The use of electronic patient records (EPRs) in maternity services: professional and public acceptability, commissioned by the Department of Health (DH). The main methods used were: --Literature review. --A national telephone survey of heads of midwifery (HOMs) in England (2001). --Case studies of maternity services in four NHS Trusts (2002). One of the findings of the research was that midwives and HOMs considered they had little knowledge of what EPRs are, and most were confused about whether their existing maternity information system (MIS) constituted an EPR system. The exact nature of EPRs was also contested among information technology (IT) professionals and NHS Trusts' EPR development strategies varied. Each Trust was, and still is, developing their own response to Information for health (NHS executive, 1998). Broadly speaking, these fell into one of two main categories of approach to EPR development. First, a 'best of breed' approach meant that departmental information systems, such as MISs were to be part of future EPR systems, and these specialist systems would become part of an inter-connected EPR system by being gradually connected with other departmental and Trust-wide information systems. Second, a 'big bang' or 'one-system' approach meant all departmental systems were in the process of being replaced by a single supplier's system for the whole Trust, and specialist departments were expected to meet their information needs by using specialist modules within this system. The relative merits of each approach were hotly debated both locally and nationally during the course of the research project. Another finding was that midwives had little interest in EPRs, although the views expressed were contradictory. While midwives were not interested in being involved in EPR developments, they did want to see midwifery interests represented. Nearly all midwives and midwifery managers expected their perspective to be provided by the 'IT midwife'. The definition of this role varied in different services. Also, the research found that not all IT midwives were accepted by colleagues as appropriate representatives of their needs. At a time when there are increasing pressures on midwives to expand their role, (Department of Health, 1999: RCM, 2002b) we argue that midwives should play a more proactive role in the development of EPRs. The example is given of the claim that EPR systems save practitioners time (NHS executive, 1998). The research showed that maternity EPR systems consumed more time for midwives than they saved, although where midwives could see the clinical value of having the system this burden was considered more acceptable. Midwives should ask more questions about the value of the information systems they use and the new EPR systems that are being rolled out, and this needs to be encouraged by midwifery educators.

Helping health and social care professionals to develop an 'inequalities imagination': a model for use in education and practice.

BACKGROUND: The 'inequalities imagination model' originated from our own research, and led to findings and recommendations regarding clinical and education issues. This article focuses on the creation of the model which, we suggest, could be used to facilitate the development of an 'inequalities imagination' in health and social care professionals. AIM: To describe and critically analyse the thinking that led to the concept of an 'inequalities imagination' and provide the framework for the theoretical model. METHODOLOGICAL APPROACH: Influencing concepts from the fields of social work, sociology, nursing and midwifery, and debates around antidiscriminatory and antioppressive practice, cultural safety, cultural competence and individualized care are analysed. INEQUALITIES IMAGINATION MODEL: Ideas generated from an analysis of the concepts of antidiscriminatory/anti-oppressive practice and from the research data led us to conceptualize a flexible model that incorporated issues of individual and structural agency and a broad definition of disadvantage. The literature review underpinning the theoretical framework means that the model has the potential to be truly interdisciplinary. CONCLUSIONS: Professional educators face a difficult task in preparing practitioners to work with clients in ways that take account of differences in background and lifestyle and which respect human rights and dignity. The model makes explicit a process that enables practitioners to think about their current practice and move towards a greater understanding and awareness of the way they work with disadvantaged clients, and ways in which they prepare others to do so. We suggest that professionals develop an 'inequalities imagination' in order to enhance equality of care. The development of an 'inequalities imagination' helps practitioners to bridge the gap between the challenges they face in day-to-day practice and what they need to achieve to aspire to provide equality of care to all.