Beake Sarah, Clark Louise L, Turner Toni, Bick Debra
Kings College London, Florence Nightingale School of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom.
Nurse Educ Today. 2013 Aug;33(8):901-6. doi: 10.1016/j.nedt.2012.08.007. Epub 2012 Sep 14.
Recent reports have highlighted the poor quality of health care received by people with intellectual disabilities (otherwise known as 'learning disabilities') in the United Kingdom (UK). UK Confidential Enquiries into maternal deaths have highlighted adverse pregnancy outcomes for women with intellectual disabilities and need for timely and appropriate clinical care.
To develop and test a competency assessment tool to support midwifery care of women with intellectual disabilities.
A mixed methods study.
Large inner city maternity unit.
Midwives and key experts in intellectual disabilities, maternity policy and midwifery education.
Phase one comprised a systematic narrative review of the literature. Evidence identified informed phase two which included focus groups and interviews. Emergent themes informed the development of a competency assessment tool which was piloted in phase three.
Phase one: Four primary research papers and two systematic reviews met the review inclusion criteria. Support to develop parenting skills of women with intellectual disabilities was highlighted as was the need to optimise organisation of maternity services. No studies specifically considered midwifery competencies to support women with intellectual disabilities. Phase two: 23 midwives attended three focus groups and individual interviews were conducted with national leaders in intellectual disability (n=6) and midwifery policy and education (n=7). Themes identified included need for individualised care provided by a known midwife, the importance of effective communication skills and need for clear knowledge and understanding of the legislative framework relevant to intellectual disability. Phase three: A convenience sample of 60 midwives was asked to participate in a pilot study to test the tool, 46 (77%) of whom responded. Thirty midwives (65%) felt competent in their ability to recognise intellectual disability and 37 (80%) competent or expert in understanding women have the right to be offered choice and make informed decisions. A high proportion (n=40, 87%) reported little or no knowledge regarding consent issues.
Work to inform timely and appropriate care of women with intellectual disability has been neglected in the UK maternity services. Use of a tool could aid assessment of midwifery competencies to support women with intellectual disability and highlight where further midwifery education and development are needed. Evidence of optimal care for women with intellectual disabilities and their families across the continuum of pregnancy and birth is required.
近期报告强调了英国智力残疾（又称“学习障碍”）患者所接受医疗保健的质量较差。英国孕产妇死亡保密调查突出了智力残疾女性不良的妊娠结局以及及时、恰当临床护理的必要性。
开发并测试一种能力评估工具，以支持对智力残疾女性的助产护理。
一项混合方法研究。
大型市中心产科病房。
助产士以及智力残疾、孕产妇政策和助产教育方面的关键专家。
第一阶段包括对文献进行系统的叙述性综述。所确定的证据为第二阶段提供了信息，第二阶段包括焦点小组和访谈。新出现的主题为能力评估工具的开发提供了信息，该工具在第三阶段进行了试点。
第一阶段：四篇主要研究论文和两篇系统综述符合综述纳入标准。强调了对提高智力残疾女性育儿技能的支持，以及优化产科服务组织的必要性。没有研究专门考虑支持智力残疾女性的助产士能力。第二阶段：23名助产士参加了三个焦点小组，并对智力残疾领域（n = 6）以及助产政策和教育领域的国家领导人（n = 7）进行了个人访谈。确定的主题包括需要由熟悉的助产士提供个性化护理、有效沟通技巧的重要性以及需要清楚了解与智力残疾相关的立法框架。第三阶段：邀请了60名助产士组成的便利样本参与一项试点研究以测试该工具，其中46名（77%）做出了回应。30名助产士（65%）认为自己有能力识别智力残疾，37名（80%）认为自己在理解女性有权获得选择并做出明智决定方面有能力或为专家水平。很大一部分（n = 40，87%）报告称对同意问题了解很少或一无所知。
在英国产科服务中，为智力残疾女性提供及时、恰当护理的相关工作一直被忽视。使用一种工具有助于评估助产士支持智力残疾女性的能力，并突出需要进一步进行助产士教育和发展的方面。需要有证据表明在整个妊娠和分娩过程中为智力残疾女性及其家庭提供了最佳护理。
