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Clinical Updates

Being a midwife is more than just “delivering babies”

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To be a midwife is to be ‘with women’,
And helping them prepare for their tiny little human,
It’s making sure baby’s growing by measuring the bump,
It’s listening to the heart rate, there’s nothing like that little thump.

It’s discussing fetal movements, they’re the most important sign,
It’s reassuring an anxious mum that everything is fine,
It’s running antenatal classes, so parents know what to expect,
But no matter how much you know there’s lessons to be learned in retrospect.

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it’s a sudden gush of water, spew and mucous plugs,
It’s women demanding that we get her bloody drugs,
It’s dimmed lighting and relaxation that often does the trick,
It’s sometimes ladies screaming that their husband is a pr*ck.

It’s running round for twelve-hour shifts and the smelly feet,
It’s knowing slimming world won’t approve of all the sweets you eat,
Its putting dad at ease when the baby comes,
it’s watching the magical moment when women become mums.

It’s observing and applauding when everything goes right,
It’s helping women feed in the middle of the night,
It’s supporting parents in their decision for bottle or for breast,
Either way is okay, a happy mum and baby’s best.

It’s being a good listener, or laughing over a cup of tea,
It’s empowering women and measuring bedpans full of pee,
It’s sharing information and putting up IV drips,
It’s the sweeps to bring on labour, with your magic fingertips.

It’s reviewing ctg traces, sometimes trace after trace,
It’s transfers round to labour ward, running at some pace,
It’s staying calm and collected when things don’t go to plan,
And when mums start to doubt themselves it’s telling them ‘you can’.

But sadly it’s not every day things go hunky dory,
If only every day we walked away with a happy story,
But not all births are happy, some angel babies we will mourn,
Their tiny little footprints leave a big impact when they’re born.

It’s the never-ending learning, something new in every day,
Its the stressful shift and the days you swear your hairs are turning grey,
It’s working as a team, things go smoother when you do,
It’s skipping breaks to get work done but squeezing time in for a brew.

It’s hearing the same questions, like ‘when baby comes will I poo?’
It’s the bladder damage because you can’t get to the loo,
It’s buzzers going off left, right and centre,
It’s working with students and trying your best to be a mentor.

It’s walking out the ward an hour later than you should,
It’s going home to your flatmate who gets the brunt of your bad mood,
It’s the food filled tea trolleys whilst everyone else is in their bed,
And when you do get to bed, its jobs still running through your head,
Did I document that on badger? Did I do all that I could,
It’s your colleagues reassuring you not to worry ‘it’s all good’.

It’s not mentioning the ‘Q’ word, you just enjoy it whilst it lasts,
It’s booking annual leave when you see a full moon is forecast,
It’s the shambles of a handover after the most chaotic day,
But it’s rewarding and fulfilling in every single way.

It is loving our job for all the good and the bad,
To be a midwife, we must be bloody mad!
This poem makes it sound like we’re all a bunch of crazies,
But you have to be,
because being a midwife is more than just delivering babies. ?

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Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Nurse with patient in bed

Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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Observations

A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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