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Midwives told to replace ‘disrespectful’ phrases with ’empowering’ alternatives

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Midwives have been told to use phrases that are “disrespectful” to women and instead uses “empowering” terminology.

The British Medical Journal (BMJ) article titled “Humanising birth: Does the language we use matter?” gives examples of poor language use followed by the suggested alternative.

Examples include; the Labour Ward should now be called the “Birthing Suite”, a big baby should be called a “healthy baby” and the term fetal distress should be altered to “changes in the baby’s heart rate pattern”.

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The three experts devised the list of “disrespectful” common terms, in the hope, it will ensure women are ‘empowered to make decisions’.

The document goes on to challenge the use of complex clinical acronyms that non-healthcare professionals may not understand or phrases that could cause distress.

Phrases such as “terminate pregnancy” should be avoided and instead, patients should be told they are undergoing a “compassionate induction”.

Writing in the BMJ, the authors said;

“Language matters as a way of respecting women’s views and ensuring that they are empowered to make decisions.

“The use of insensitive language can be indicative of an underlying malaise, which reveals underlying attitudes and prejudices.

“It is essential that we achieve respectful practice, ensuring that women have complete understanding and control of their own care.”

“Good communication during the birthing process is critical to good maternity care, but achieving a shift in deeply ingrained language, and the thinking it reflects, is difficult.

“There is a fine line between changing terminology to integrate language which is more respectful, inclusive, and less intimidating for the mother, and substituting vague, verbose language which hinders the original message.”

Recent updates to the NICE Intrapartum Care Guidelines emphasise the importance of good intrapartum communication and respect for women’s autonomy.

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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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