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Nursing theories can be defined in different perspectives in modern times. According to Meleis (2012), nursing theory is a conceptualization of the realities in practical nursing. The objectives of the theoretical aspect  is to explain the association between specific types of phenomena, the reason for describing the case, predictions of the nursing  impact and prescription of nursing care on patients. The conceptual frameworks are the basis for decision-making and nursing practice. Nursing theories are categorized in three groups, which are grand theories, middle range theories and situational theories. For the purposes of the paper, grand theories are defined as frameworks established through experiences, studies, observations and insights. The research focuses on the use of nursing theories in influencing policy aspects of child delivery in the American context.

The Current Nursing Practice

American and Canadian Aboriginal midwives have encountered social, political and cultural huddles in their profession for a long time. The challenges have negatively influenced health outcomes and cultural aspects. Further, modernization and advancement in technology had diminished the role of a traditional midwife. However, the new perspective with regard to the American and Canadian government views on the traditional midwives should reverse the practice. In fact, a new trend appears to incorporate the merging of a traditional midwife with modernity so as to provide an enhanced maternity service as an attempt to boosting the health care delivery to pregnant women.

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In recent perspectives, the updated midwifery practices have been assimilated in the majority of the United States of America. The modern midwifes are classified under various designates like the CPM, CNM, and the CM basing both on their certification and the number of years worked. The method of payment for their services also differs depending on states and regions. However, the interesting fact is that midwifes provide their assistance in many localities, and the demand has almost become uniform in several regions and states. The paper argues that in line with Johnson Dorothy of Behavioral Functioning in nursing, the government and other key stakeholders should set initiatives to offer the midwives a responsibility for the child delivery. They need to participate in special training and adequate preparation to fulfill their job requirements and empower them in the profession. Consequently, the quality of health care in child delivery would be improved. 

The Need to Change the Current Midwifery

A number of midwives in America do not advance in education as a necessary factor in their profession. The assumption is that education of a nurse or a midwife prepares an assistant to physicians, rather than independent professional. The current approach also argues that midwives should be allowed to practice their profession independently. Moreover, most courses in midwifery education are often taught at the university level. The midwives have “direct entry”, which means that there no nursing or any other education papers required. Further, it should also be considered that since midwifery education was only established in the late 1990s, the majority of the practicing midwives have either no educational background or training in that area or have received their education in other institutions.

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Key Stakeholders

Currently, practicing midwives are categorized under different titles such as CNM, CM, and CPM depending on their experience and certification. The Certified Nurse Midwives are trained as nurses, but have an extra education in midwifery. A Certified Midwife, on the other hand, has the same credentials as the CNM. The only difference is that the CM has a college degree that is not related to nursing. The last group is the Certified Professional Midwives, who have rigorous training and pass through the American Registry of Midwives. Moreover, it should be noted that ACPM practices the profession independently.

According to Hamric (2009), nurse midwives must be able to exhibit expertise in their profession, excellent communication skills and commitment to their clients’. The midwives must also be willing to cooperate with doctors and other colleagues. The nurse should further respect her or his colleague’s ideas.

Theoretical Perspective

The case studies and surveys by Benoit (2011) are based in the U.S, U.K and Canada. The article is published by Routledge Publisher. The work is reviewed and commended by renowned midwives and educators in America. The evidence is strongly supported and claims that nurses should be given autonomy and independence in order to work effectively.

Another strong expert opinion isa critical review by Paterson (2011) with assessment of various policy texts. The study reveals that the legislation and its related regulations not only highlight the satisfaction of clients, but also the competency of the midwives and the group of clients they serve. In his book, Hamric (2009) assess the chronological facts on the history of APN, the theoretical perspectives of nursing as well as the ethical and legal issues surrounding nursing. Moreover, the author notes that healthcare practitioners should be supported and well trained.

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Johnson (2011) explains that nursing is the fostering of effective and efficient behavioral functioning of the patient to curb or prevent sickness. Therefore, midwives can only be able to effectively foster behavioral functioning among patients if they are well trained to do so. According to Peckham, Hann and Boyce (2011), health promotion enhances lifestyle control of healthcare consumers. Therefore, they can make informed decisions concerning their health. Nurses and midwives need to undertake health promotion as a means of resolving issues and challenges that their clients encounter. Moreover, they are expected to communicate any prevalent or emerging issues concerning their health to the clients. Promotion of wellbeing is expected to equip clients with the insights that are necessary in addressing health issues that they encounter.

Therefore, nurses and midwives are supposed to be equipped with knowledge and skills in conducting health promotion among clients. The process will be efficient only if both the practitioners and the clients have the necessary skills and capabilities. The quality of improvement is reinforced if the parties are mobilized in controlling their choices and actions according to the health aspects of their environment. Further, positive health attitudes should be instilled among clients by nurses and midwives, so that they can understand why and how to maintain their conditions.

According to the Johnson’s model, there has to be an interaction, organization, integration of various elements and parts and interdependency of behaviors to establish the whole system. Rodgers (2000) adds that the uniqueness of nursing and midwifery is derived from the fact that they are a science and an art at the same time. He theorized that nurses and midwives ought to be concerned with clients and their relationship with immediate environment as an important element for improving the health care condition. According to the author, the nature of individuals is complex and different with regard to the totality of their various parts. The relation of individuals to the immediate environment is an essential aspect for coordinating the multidimensional elements of the open systems.

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Johnson (2011) claims that the aims of nursing are to help a patient whose actions side with the social demands. Moreover, patients have to possess the ability to adapt to an alteration in his behavior in a manner that supports the biological essentials. The patient is supposed to benefit fully when it comes to the attention from the practitioner’s knowledge or in terms of healthcare provision. In a bid to offer the complete advantage to the patient, midwives are supposed to have gone through an exceptional training in order to inculcate the vital knowledge and skills.

The Johnson’s model can be applied as a conceptual framework for evaluating the needs of pregnant women during child delivery. In particular, the model is a practical tool for implementing all phases of the child delivery encompassing the mother’s feeling, desires, and needs.

Fruehwirth (2000) points out that a combination of Johnson’s model and Piagetian theory allows the midwives to objectively describe the behavior of patients, which serves to point out the presence of any particular disequilibrium. Further, the model could be used effectively in a group situation by midwives, where choice making and problem solving in adapting to lifestyle changes are a necessary requirement.

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Conclusion

Professional midwives should be qualified to offer maternal services that are critically required in the society. Their services can be used in solving the health crisis involving the congestion of the maternity wards caused by the incompetent nurses, who are not trained in midwifery. CPM care should be made safer, accessible and cheaper to the clients. In addition, the midwife care should be oriented towards the customer care and support. The result is collaboration between the client and caregiver. The kind of care is most needed in our sector today to solve maternity woes in many health care settings. 

The use of Johnson’s model in evaluating the client’s behavioral system is an effective way of determining the various factors which can stir the ability of an individual to cope with the health challenges. For instance, caregivers or practitioners have to instill the necessary knowledge among their clients on how to manage or cope with a particular situation. Consequently, such practitioners must also have the required education and skills alongside the communication skills to help their clients. Therefore, the case necessitates that midwife practitioners have to be trained accordingly in the required aspects. The midwives with no or low level training are at a disadvantaged position in regard to the provision of proper care to their patients. Application of models and theories for evaluating clients enables professional nurses and midwives to categorized observed phenomena and gain insights in the various contexts they are handling.