Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, B9 5SS, UK.
School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
BMC Pregnancy Childbirth. 2017 Sep 2;17(1):282. doi: 10.1186/s12884-017-1472-8.
For the past decade, Maternal Mortality Reports, published in the United Kingdom every three years, have consistently raised concerns about maternal observations in maternity care. The reports identify that observations are not being done, not being completed fully, are not recorded on Early Warning Score systems, and/or are not escalated appropriately. This has resulted in delays in referral, intervention and increases the risk of maternal morbidity or mortality. However there has been little exploration of the possible reasons for non-completion of maternal observations.
The aim of this study was to explore midwives' experiences of performing maternal observations and escalating concerns in rural and urban maternity settings in the West Midlands of England. A qualitative design involving a series of six focus groups with midwives and Supervisors of Midwives was employed to investigate the facilitators of, and barriers to the completion of maternal observations.
Eighteen Midwives and 8 Supervisors of Midwives participated in a total of 6 focus groups. Three key themes emerged from the data: (1) Organisation of Maternal Observations (including delegation of tasks to Midwifery Support Workers, variation in their training, the care model used e.g. one to one care, and staffing issues); (2) Prioritisation of Maternal Observations (including the role of professional judgement and concerns expressed by midwives that they did not feel equipped to care for women with complex clinical needs; and (3) Negotiated Escalation (including the inappropriate response from senior staff to use of Modified Early Warning Score systems, and the emotional impact of escalation).
A number of organisational and cultural barriers exist to the completion of maternal observations and the escalation of concerns. In order to address these the following actions are recommended: standardised training for Midwifery Support Workers, review of training of midwives to ensure it addresses the increasing complexity of the maternal population, identification and agreement regarding the organisation of maternal observations among staff, an emphasis on increasing the priority placed on maternal observations in all clinical settings, and clarification and reinforcement of escalation procedures for both midwives and senior clinicians.
在过去的十年中，英国每三年发布一次的《孕产妇死亡率报告》持续对产妇护理中的观察问题表示担忧。报告指出，观察工作未完成、未全面完成、未记录在早期预警评分系统中、/或未得到适当升级。这导致了转介、干预的延迟，并增加了产妇发病率或死亡率的风险。然而，对于未完成产妇观察的可能原因，几乎没有进行过探索。
本研究的目的是探讨英格兰西米德兰兹农村和城市产科环境中助产士进行产妇观察和升级问题的经验。采用定性设计，包括与助产士和助产士主管进行的六组焦点小组，以调查完成产妇观察的促进因素和障碍。
共有 18 名助产士和 8 名助产士主管参加了总共 6 个焦点小组。从数据中出现了三个关键主题：（1）产妇观察的组织（包括将任务分配给助产士支持人员、他们培训的差异、所使用的护理模式，如一对一护理、和人员配备问题）；（2）产妇观察的优先事项（包括专业判断的作用以及助产士表示他们不具备照顾有复杂临床需求的女性的能力的担忧）；和（3）协商升级（包括高级工作人员对使用改良早期预警评分系统的不当反应、以及升级带来的情绪影响）。
完成产妇观察和升级问题存在一些组织和文化障碍。为了解决这些问题，建议采取以下行动：为助产士支持人员提供标准化培训、审查助产士培训以确保其涵盖产妇人群的日益复杂性、在员工中确定并达成产妇观察的组织共识、在所有临床环境中强调增加对产妇观察的重视、以及明确和加强助产士和高级临床医生的升级程序。
