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Clinical Updates

Midwives get guidance on how to support homeless women

The Homelessness Reduction Act places a duty of care on professionals to help the homeless or those at risk of homelessness.



Homeless Pregnant Woman

Midwives have a duty of care to offer help to those who are homeless or at risk of homelessness.

New guidance for midwives to support women who are homeless or at risk of becoming homeless has been published by the Royal College of Midwives.

The Homelessness Reduction Act (HRA) came into force in England on 3rd April 2018 to prevent and stop homelessness by offering early support to those at risk of becoming homeless or who are homeless.  It also places a new duty on health services, including maternity, to help those who are homeless or at risk of homelessness.


Aimed at midwives and maternity support workers (MSW) and using real-life scenarios, the guidance will help them spot the signs of homelessness or those at risk of it. It also gives information about how to refer women, with their consent, to housing services that can help them. Pregnant women are among those considered a priority for housing.

If midwives suspect a woman is at risk they will ask women about their housing situation on at least four occasions at certain points in their pregnancy.  These are at the first appointment with the midwife then at 28 weeks, 36 weeks and on discharge after the birth.

Helping the ‘most vulnerable’ in society.

The guidance recognises that women booking into maternity services may be disclosing their homelessness to a professional for the very first time. A new pregnancy is a daunting time for a lot of women and those with the added worry of securing suitable accommodation in good time for their baby’s arrival will have a particular need for advice and support.

Commenting on the guidance, Gill Walton, Chief Executive and General Secretary of the Royal College of Midwives, said: “We have got to do everything we can to help and support those most vulnerable in our society. We know that vulnerable women such as this can experience more problems in their pregnancy and that this can have an adverse effect on their baby also. That is why I am so delighted that the RCM has published this guidance for midwives and MSWs so that they can support and help these women.”

Val Clare, Head of Midwifery for Bolton NHS Foundation Trust said: “We’re delighted to welcome the Mayor of Greater Manchester, Andy Burnham along to Ingleside Birth and Community Centre today, and to share in the launch of this new guidance. As midwives, we have a unique relationship with the women in our care, and I’m proud to be part of the first professional body in the NHS to put guidance in place as to how we support women when they are at their most vulnerable.”

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.



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.


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’. 




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.


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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