Use of a birth plan within woman-held maternity records: a qualitative study with women and staff in northeast Scotland.

BACKGROUND: Birth plans are written preferences for labor and birth which women prepare in advance. Most studies have examined them as a novel intervention or "outside" formal care provision. This study considered use of a standard birth plan section within a national, woman-held maternity record. METHODS: Exploratory qualitative interviews were conducted with women (42) and maternity service staff (24) in northeast Scotland. Data were analyzed thematically. RESULTS: Staff and women were generally positive about the provision of the birth plan section within the record. Perceived benefits included the opportunity to highlight preferences, enhance communication, stimulate discussions, and address anxieties. However, not all women experienced these benefits or understood the birth plan's purpose. Some were unaware of the opportunity to complete it or could not access the support they needed from staff to discuss or be confident about their options. Some were reluctant to plan too much. Staff recognized the need to support women with birth plan completion but noted practical challenges to this. CONCLUSIONS: A supportive antenatal opportunity to allow discussion of options may be needed to realize the potential benefits of routine inclusion of birth plans in maternity notes.

A literature review of principles, policies and practice in extended nursing roles relating to UK intensive care settings.

AIMS: To provide an overview of the literature relating to the principles, policy and practice of extended nursing roles in UK intensive care settings to date; to review and critically assess evidence of impact, outcomes and effect on practice and provide suggestions for future research. BACKGROUND: It is known that career development opportunities, new technologies, patient needs, as well as the reduction in junior doctors' hours, are driving the development of new roles for nurses. Policy initiatives aim to expand nursing roles to support professional substitution. In adult, neonatal and paediatric intensive care, specialist trained nurses and designated advanced nursing practitioners are increasingly taking on extended practice of clinical tasks previously undertaken by medical staff. As yet there are no statutory regulations on the perceived scope and definition of the role of extended and advanced roles. DESIGN: Systematic review. METHODS: Search of electronic databases and selection of policy and peer-reviewed reports and reviews of extended nursing roles or advanced nursing practitioners in UK intensive care settings. RESULTS: Chronological review shows policy development proceeding in a relatively ad hoc way. There is limited information available about how extensively or effectively extended nursing roles are being implemented in intensive care settings in the UK, particularly in adult and paediatric intensive care. To test local initiative findings for reliability and generalisability, a more robust evidence base is required. CONCLUSIONS: More data are needed on definition and outcomes of extended nursing roles in intensive care and care process measures should be developed to better inform implementation of nurse role development in the UK. RELEVANCE TO CLINICAL PRACTICE: The review of policy and research evidence in this paper may better inform clinicians working in adult, neonatal or paediatric intensive care, as they continue to be challenged by expansion and development of their role. It may also help to form a basis and evaluation for future research into extended and advanced nursing roles in intensive care settings.

Midwives' competence: is it affected by working in a rural location?

INTRODUCTION: Rising health care costs and the need to consolidate expertise in tertiary services have led to the centralisation of services. In the UK, the result has been that many rural maternity units have become midwife-led. A key consideration is that midwives have the skills to competently and confidently provide maternity services in rural areas, which may be geographically isolated and where the midwife may only see a small number of pregnant women each year. Our objective was to compare the views of midwives in rural and urban settings, regarding their competence and confidence with respect to 'competencies' identified as being those which all professionals should have in order to provide effective and safe care for low-risk women. METHOD: This was a comparative questionnaire survey involving a stratified sample of remote and rural maternity units and an ad hoc comparison group of three urban maternity units in Scotland. Questionnaires were sent to 82 midwives working in remote and rural areas and 107 midwives working in urban hospitals with midwife-led units. RESULTS: The response rate from midwives in rural settings was considerably higher (85%) than from midwives in the urban areas (60%). Although the proportion of midwives who reported that they were competent was broadly similar in the two groups, there were some significant differences regarding specific competencies. Midwives in the rural group were more likely to report competence for breech delivery (p = 0.001), while more urban midwives reported competence in skills such as intravenous fluid replacement (p <0.001) and initial and discharge examination of the newborn (p <0.001). Both groups reported facing barriers to continuing professional development; however, more of the rural group had attended an educational event within the last month (p <0.001). Lack of time was a greater barrier for urban midwives (p = 0.02), whereas distance to training was greater for rural midwives (p = 0.009). Lack of motivation or interest was significantly higher in urban units (p = 0.006). CONCLUSION: It is often assumed that midwives in rural areas where there are fewer deliveries, will be less competent and confident in their practice. Our exploratory study suggests that the issue of competence is far more complex and deserves further attention.

Risk of skin cancer after neonatal phototherapy: retrospective cohort study.

OBJECTIVE: To assess the risk of skin cancer in persons treated with neonatal phototherapy (NNPT) for jaundice. DESIGN: Retrospective cohort study. SETTING: Grampian Region, Scotland, UK. DATA SOURCE: Aberdeen Maternity and Neonatal Databank. NNPT exposure was abstracted from paper records spanning 1976-1990. Follow-up to 31 December 2006 by linkage to cancer registration and mortality records. MAIN OUTCOME MEASURES: Incidence ratios, standardised for age, sex, calendar period and socio-economic position. RESULTS: After excluding neonatal deaths (n=435), the cohort comprised 77,518 persons. 5868 Received NNPT, providing 138,000 person-years at risk (median follow-up, 24 years). Two cases of melanoma occurred in persons exposed to NNPT versus 16 cases in unexposed persons, yielding a standardised incidence ratio of 1.40 (95% CI, 0.17 to 5.04; p=0.834). No cases of squamous cell or basal cell carcinoma of skin were observed in exposed persons. CONCLUSIONS: Although there is no statistically significant evidence of an excess risk of skin cancer following NNPT, limited statistical power and follow-up duration mean it is not possible categorically to rule out an effect. However, taken in conjunction with the results of the only other study to investigate risk of melanoma following NNPT, evidence available so far does not suggest a major cause for concern.

Factors associated with self-reported first sexual intercourse in Scottish adolescents.

BACKGROUND: There is continuing concern about high pregnancy rates and increasing numbers of sexually transmitted infections being detected in Scottish adolescents. Consistent evidence about factors associated with risky sexual behaviours, including early first sexual intercourse, may help to identify adolescents at risk and help improve interventions. This study aimed to provide detailed analysis of the evidence of the associations between individual factors and early sexual intercourse using cross-sectional questionnaire data from 4,379 Scottish adolescents who participated in a sexual health intervention evaluation. FINDINGS: Multivariate secondary analysis showed that aspects of family and school life such as decreasing parental monitoring (OR 1.45, 95% CI 1.24-1.70) and decreasing enjoyment of school (OR 2.55, 95% CI 2.15-3.03) were associated with reporting previous sexual intercourse. Furthermore, females were more likely to report previous sexual intercourse than males (OR 1.48, 95% CI 1.14-1.91). Several factors commonly used to inform sexual health intervention design, such as socioeconomic status, self-esteem and religion, were not independently associated. CONCLUSION: These results contribute to the evidence base for the association of several factors with early initiation of sexual activity. The findings suggest that interventions aiming to delay first intercourse may need to consider targeting aspects of individuals' connection to their school and family. Furthermore, the results do not support the need to consider socio-economic background, religion or self-esteem of the individuals in intervention design.

The effect of the national demonstration project Healthy Respect on teenage sexual health behaviour.

BACKGROUND: As part of the independent evaluation of Healthy Respect (a national demonstration project to improve teenage sexual health in Scotland) this study examined the effect of the school-based sexual health education intervention comprising multiprofessional classroom delivery and alongside drop-in clinics on teenage sexual behaviour outcomes. METHODS: Before-and-after cross-sectional surveys of secondary school pupils (average age 14 years and 6 months) were used in 10 Healthy Respect intervention schools in Lothian region and 5 comparison schools without intervention in Grampian region (2001 and 2003). RESULTS: By 2003, the proportion of pupils in Lothian feeling confident about getting condoms and using condoms properly significantly increased, more Lothian pupils (particularly boys) showed improved knowledge about condoms being protective against sexually transmitted infections. No further evidence of improved knowledge, attitudes, or intentions was evident after the intervention. Pupils in Lothian remained more likely to think using a condom would be embarrassing (especially girls), would reduce sexual enjoyment (especially boys), and intentions about condom use (as closer predictors of actual behaviour change) showed no significant improvement. More Lothian ( approximately 24%) than Grampian ( approximately 19%) pupils report having had sexual intercourse at age <16 years, both before and after the intervention, with no evidence of a significant reduction in Lothian by 2003. Overall differences in attitudes to condom use by gender were noted. Findings remain consistent in both unadjusted and adjusted comparisons. CONCLUSION: These findings demonstrate limited impact on sexual health behaviour outcomes, and raise questions about the likely and achievable sexual health gains for teenagers from school-based interventions.