Attendance at pre-pregnancy care clinics for women with type 1 diabetes: A scoping review.

INTRODUCTION: Type 1 diabetes mellitus occurs in one in every 275 pregnancies and can result in increased morbidity and mortality for both mother and baby. Several pregnancy complications can be reduced or prevented by attendance at pre-pregnancy care (PPC). Despite this, less than 40% of pregnant women with pre-gestational diabetes receive formal PPC. The aim of this scoping review is to identify the barriers to PPC attendance among women with type 1 diabetes. METHODS: We conducted a scoping review by searching five databases (Ebsco, Embase, Ovid and PubMed for literature and the ProQuest for any grey/unpublished literature) for studies in English between 2000 and 2022. Studies that evaluated attendance at PPC for women with type 1 diabetes were included. RESULTS: There are multiple barriers to PPC attendance, and many of these barriers have been unchanged since the 1990s. Identified barriers can be grouped under patient-centered and clinician-centered headings. Patient factors include knowledge and awareness, unplanned pregnancies, negative perceptions of healthcare and communication issues, unclear attendance pathways and logistical issues including time off work and childcare. Clinician factors include physician knowledge, time constraints and lack of comfort discussing pregnancy/contraception. CONCLUSION: This review highlights the ongoing problem of poor attendance at PPC and identifies key barriers to be addressed when developing and implementing PPC programs for women with type 1 diabetes.

The experiences of being a registered nurse prescriber within an acute service setting.

AIMS AND OBJECTIVES: To explore the experiences of nurse prescribers in an acute service setting. DESIGN: A descriptive phenomenological design underpinned by Husserl's philosophy was used as the guiding framework. METHODS: Data were collected using semistructured interviews and purposive sampling of 11 current registered nurse prescribers from two acute hospitals. Colaizzi's seven steps were employed to analyse the data and develop themes which reflected the participants' experiences of prescribing. RESULTS: The study identified three themes: Enhanced Patient Care, Impact on the Nurse as a Prescriber and the Challenges of Nurse Prescribing. The nurses interviewed were proud to be prescribers and perceived their prescribing practice as safe. This was a unique finding, not described by other research. Increased job satisfaction was also important to those interviewed as identified in previous studies pertaining to prescriptive authority. Ongoing challenges affecting prescribers included staff shortages, extra workload arising from prescribing and the need to educate colleagues about nurse prescribing. Those interviewed also suggested standardising both the prescribing course and local Drugs and Therapeutics Committees nationally, to overcome identified issues. CONCLUSIONS: Further research into the safety of nurse prescribing is recommended to ascertain if what was described locally applies nationally. A larger study into the experiences of nurse and midwife prescribers is also required, to promote and maintain this practice and to ensure future prescribers embrace this extended scope of practice. RELEVANCE TO CLINICAL PRACTICE: Insight into how nurse prescribers feel about prescriptive authority. Highlights the advantages and disadvantages of this extended scope of practice. RNPs describe how to overcome some of the barriers they have encountered with useful suggestions being made for practice development and further research.

VBAC or elective CS? An exploration of decision-making process employed by women on their mode of birth following a previous lower segment caesarean section.

BACKGROUND: Part of the caseload of an Advanced Midwife Practitioner (AMP) service in a Northwest of Ireland maternity unit includes vaginal birth after caesarean section (VBAC) women. Despite evidence about VBAC being a safe option for women, the numbers attempting a VBAC remain small. This research was undertaken to give an insight into how VBAC eligible women opt for an elective repeat CS (ERCS) or VBAC birth. METHODS: Forty-four postnatal women with one previous CS who birthed between August 2021 and March 2022 were invited to participate in a qualitative study. Thirteen semi-structured interviews were undertaken in 2022. Thematic Analysis guided the analysis of the data and the findings are framed using the domains of the Socio-Ecological Model. FINDINGS: Decision making in relation to ERCS and VBAC is complex. Women want accurate VBAC information and time for discussions. Decisions are influenced by the woman's own confidence to birth naturally, family size, rite of passage to motherhood, control, previous birth experience, postnatal recovery and friends and family. DISCUSSION: Previous experience can influence but not predict the next mode of birth. However, there is no one script that healthcare professionals (HCP) can use for this decision making given the various factors that influence this. To meet women's individual needs, HCPs should discuss VBAC suitability postnatally, offer VBAC antenatal clinics and specific VBAC classes. CONCLUSION: Discussions about suitability for VBAC should occur following the primary CS. Continuity of care (COC), time for discussions and VBAC supportive HCP should be an option for all of this cohort.

Sign in, time out, sign out checklist-changing practice through interdepartmental teamwork to improve safety at caesarean section.

Three similar clinical incidences over a three-month period highlighted an issue with the readiness and availability of neonatal resuscitation personnel and equipment at the time of caesarean section (CS). This identified a potential risk to the wellbeing of the mother and baby that had to be addressed. A joint venture was undertaken with the maternity and theatre directorates. A maternity-specific checklist in use in the UK maternity services was sourced, adapted and implemented. No further incidents have been reported since with resulting overall enhanced safety of pregnant women and newborn babies in the unit.