Ebert Lyn, Massey Debbie, Flenady Tracy, Nolan Samantha, Dwyer Trudy, Reid-Searl Kerry, Ferguson Bridget, Jefford Elaine
Faculty of Health, Southern Cross University, Southport, New South Wales, Australia.
CQUniversity, Norman Gardens, Queensland, Australia.
Birth. 2023 Jun;50(2):438-448. doi: 10.1111/birt.12665. Epub 2022 Jul 22.
Early warning systems (EWS) are used across health care settings as a tool for the early identification of clinical deterioration and to determine the need to escalate care. Early detection of clinical deterioration and appropriate escalation of care in maternity settings is critical to the safety of pregnant women and infants; however, underutilization of EWS tools and reluctance to escalate care have been consistently reported. Little is known about midwives' use of EWS in the Australian context.
Using a cross-sectional approach, we elicited the attitudes, beliefs, and behaviors of a purposive sample of Australian midwives (n = 87) with respect to the Maternal Early Warning Trigger Tool (MEWT). Participants answered a 25-question Likert scale survey and one open-ended question. Qualitative answers were analyzed using consensus coding.
Midwives reported positive attitudes toward the MEWT, describing it as a valuable tool for identifying clinical deterioration, especially when used as an adjunct to clinical judgment. However, midwives also identified training gaps; 25% had received no training, and only half of those who had received training felt it was effective. In addition, professional tension can create a significant barrier to the effective use of the MEWT. Midwives also reported feeling influenced by their peers in their decision-making with respect to use of the MEWT and being afraid they would be chastised for escalating care unnecessarily.
Although the MEWT is valued by Australian midwives as a useful tool, barriers exist to its effective use. These include a lack of adequate, ongoing training and professional tension. Improving interdisciplinary collaboration could enhance the use of this tool for the safety of birthing women and their infants.
早期预警系统（EWS）在医疗保健机构中被用作早期识别临床病情恶化以及确定是否需要加强护理的工具。在产科环境中尽早发现临床病情恶化并适当加强护理对于孕妇和婴儿的安全至关重要；然而，一直有报告称EWS工具未得到充分利用且人们不愿加强护理。在澳大利亚的背景下，关于助产士对EWS的使用情况知之甚少。
我们采用横断面研究方法，了解了澳大利亚助产士（n = 87）的一个有目的样本对孕产妇早期预警触发工具（MEWT）的态度、信念和行为。参与者回答了一份包含25个问题的李克特量表调查问卷和一个开放式问题。对定性答案采用共识编码进行分析。
助产士对MEWT持积极态度，将其描述为识别临床病情恶化的宝贵工具，尤其是作为临床判断的辅助工具时。然而，助产士也指出了培训方面的差距；25%的人未接受过培训，接受过培训的人中只有一半认为培训有效。此外，职业紧张情绪可能对MEWT的有效使用造成重大障碍。助产士还报告称，在决定是否使用MEWT时会受到同行的影响，并且担心因不必要地加强护理而受到指责。
尽管澳大利亚助产士重视MEWT这一有用工具，但其有效使用仍存在障碍。这些障碍包括缺乏充分的持续培训和职业紧张情绪。改善跨学科合作可以提高该工具在保障分娩妇女及其婴儿安全方面的使用。
