In doing so, it provides protection to the public by having criteria against which products and the performance of practitioners can be assessed.
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Standard statements are usually expressed in behavioral and measurable terms. They will say precisely what the workers will do and how they will carry out the task. Eg: correctly, accurately, gently. It is also important that standards are realistic, desirable and achievable. Standards of practice can help identify the actual competencies required by a midwifery trained personnel in routine normal practice. Such standards can be used as the basis for assessing current practice, organizing refresher and updating programmes, as well as developing future curricula.
Each standard includes seven major components i. The code, title, aim, standard statement, outcome, prerequisites, process, and audit. The aim indicates the intended objectives of the standard.
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The standard statement describes precisely what the midwifery trained personnel will do and to what level of competence. The expected outcomes are stated in measurable terms although some of the outcomes are long term outcomes such as increased utilization of midwifery trained personnel. The pre requisites include those elements that are required to allow the health worker to perform the standard.
Eg: training, resources, knowledge, equipment, drugs and system. Process : the critical task to be followed for meeting the standard have been specified as process. The audi t is an integral part of the standard. It includes a checklist and action plan.
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The check list can be used to test or audit the standard. The action plan is the critical part of the audit. It is intended to identify the areas which need strengthening or correcting and to assist the supervisors, managers in their routine supervisory visits.
With out action following the audit, standards will be difficult to maintain and impossible to improve. The essential elements that must be in place to enable the midwifery trained personnel to carry out the standard effectively. A review or revision of the supportive regulations and policies may be necessary to allow the midwifery trained personnel to perform the standard correctly.
A series of questions to identify the deficiencies in the pre requisites and process components of standard as well as action needed to rectify the deficiencies or to strengthen the standard including target dates for completion of each action and responsible person to implement the action. To estimate gestational age, monitor fetal growth and accurately identify lie, presentation and position of the fetus. Midwifery- trained personnel have been trained in the correct procedure for conducting abdominal palpation.
Essential equipment such as tailor's measure tape and fetal stethoscope is available and in good working condition. A culturally appropriate place is available which allows privacy to conduct the abdominal palpation. A fully operational referral system is in place for the pregnant women identified as at risk or who develops complication to receive appropriate care and treatment. Ask the pregnant women prior to the palpation how she feels, if the baby is moving and when her last menstrual cycle occur or the date she felt the baby first moved.
Lay the pregnant women on her back with upper part of her body supported with cushions. Never lie a pregnant women flat on her back as the heavy uterus may compress the main blood vessels returning to the heart and cause fainting supine hypotension. Record findings and refer for institutional deliveries. If the women had a previous caesarean section or there are signs of excessive or reduced amniotic fluid or multiple pregnancy.
Estimate gestational age and assess the fetal growth. After 24 weeks of pregnancy the most effective way to estimate gestational age is to use a tailor's tape measure. Using the measuring tape, measure from the upper border of the symphysis pubis to the top of the fundus. Record the measurement in centimeters. If measurement is different from calculated weeks by more than 3 c. After 37 weeks especially in primi gravida assess the fetal head is engaged.
Record all findings accurately. Audit is defined as the systematic and critical analysis of the quality of medical care. Nursing Audit: is a means by which nurses themselves can define standards from their point of view and describe the actual practice of nursing. Objective of carrying out an audit is to improve the quality of clinical care. It is done by changing and strengthening many aspects of hospital, practice and administration.
Audit could be medical where scrutiny is done over the medical aspect of the work performed by the doctors. It could be clinical, where scrutiny is done over the work done by all health professionals including the doctors. Important aspect to organize an obstetric audit is motivation of all doctors, midwives, and other health professionals. Proper documentation of facts and figures must be there. Audit should be kept confidential and is considered as an educational tool.
As soon as feasible when there is a complaint by the midwifery- trained personnel that they are unable to fulfill the standard, or a complaint is raised by the community about the quality services,. Audit should be pre arranged with the midwifery trained personnel. This should be done over days so that the auditor can observe the midwifery trained personnel in different situations.
A well structured and efficient audit is based on scientific evidences with facts and figures. It can remove the disbelieving and agonistic attitudes between hospital management and professionals and also amongst the professionals. From the result of the audit check list, it will be possible to develop an action plan to further improve or strengthen the standard.
It is important in action plan to set target dates for completion of each task.
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If the result shoes that the standard is operating correctly, then a date should be set for re- audit of the standard annually, or as national policy states. Clinical audit is about improving practice and providing a better service for consumers.
Practice styles. A comparison of obstetricians and nurse-midwives.
Practitioners are expected to measure and demonstrate the effectiveness of the care they provide and one way of assessing practice by clinical audit. Clinical audit is a continuous process that involves identifying an area to be examined, the collection of appropriate data and the introduction of changes in practice as a result of analysis of the data. It is crucial that the effect of changes is monitored by repeating the audit and introducing further changes, if indicated.
Health care professionals are mainly concerned with the outcome of clinical intervention, but there are other aspects of clinical practice that may influence outcome. Audit may influence aspects of service structure and process as well as the outcome of clinical care. When embarking on a process of clinical audit for the first time, it is better to concentration a small area of study, and one that is amenable to change.
An example might be to improve breast feeding rates. One must decide what it is necessary to know in order to achieve this. It is extremely important to define objectives at the start of any process of audit and how the results of the process might be used to influence practice. When an area of study has been chosen, it is vital for there to be clinical consensus on what constitutes good care, that is, what should be happening, a desired level of achievement, a standard. It is likely to be easier to agree any changes as a result of the audit if clinical consensus on good care has been obtained.
Remark: - the student nurse obtains a total score of 28, which is categorized as average. Necessary corrections given to the student nurse and advised to practice regularly.
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Rule 42 UKCC requires the midwife to keep detailed records which must be made as contemporaneously as is reasonable, in other words as near the event as possible. Records must be in a form acceptable to the employer and approved by the local supervising authority. A midwife in independent practice will discuss the format of her records with her supervisor of midwives. The midwife's record is distinct from that of the doctor although she may contribute to the medical record, especially during pregnancy.
She must keep records of the midwifery history, and of all antenatal examinations which she makes. During labour, records of observations, examinations and care are essential and it is particularly important to enter details promptly, because events move on so rapidly. A register of controlled drugs is kept for the purpose of monitoring the issue and use of drugs of addiction.
The midwife's register of births is usually kept communally by hospital midwives but individually by a community midwife. Maternity units use a wide variety of records and notes, including those which are designed to be entered into a computer and others which are appropriate to the midwifery process or to varying styles of individualized care.
All records that are made by a midwife must be preserved for a period of not less than 25 years. The reason for this is that the record may be needed for the midwife's protection in case of litigation or allegations of professional misconduct. A protocol is a written system for managing care that should include a plan for audit of that care.
Most protocols are binding on employees as they usually relate to the management of consumers with urgent, possibly life threatening conditions. A protocol may exist for the care of the woman with ante partum hemorrhage but not for the care of women in labour without complication. Guidelines or procedures are usually less specific than protocols and may be described as suggestions for criteria or levels of performance which are provided to implement agreed standards.
Fraser M. D, Cooper. M, Fletcher. Myles Text book for midwives. Edinburgh: Churchill livingstone; Moree K, "what nurses learn from nursing audit", Nursing out look, January , 26 1 Basavanthappa B. Ganong J. M and Ganong W. National institute for health and clinical excellence: Audit criteria- intrapartum care; issued in Standards of midwifery practice for safe motherhood.
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Source : Online journal on issue in nursing. Nursing Management. Phelps Health Women's Health Center and Maternity offers a midwifery program together with its established women's health services. There are varying types of midwives from lay to professionally trained, but certified nurse midwives CNM and certified midwives CM are the most educated.
Wildebrandt and Ulrich are CNMs, which means they are skilled in both nursing and midwifery disciplines.