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Phillips K, Sanders J, Warren LE. UK student midwives' theoretical knowledge, confidence, and experience of intermittent auscultation of the fetal heart rate during labour: An online cross-sectional survey. Midwifery 2024; 132:103952. [PMID: 38442530 DOI: 10.1016/j.midw.2024.103952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/21/2023] [Accepted: 02/10/2024] [Indexed: 03/07/2024]
Abstract
AIM This study aimed to explore student midwives' theoretical knowledge of intrapartum intermittent auscultation, their confidence in, and their experience of this mode of fetal monitoring. DESIGN AND SETTING An online cross-section survey with closed and open questions. Descriptive statistics were used to analyse participants' intermittent auscultation knowledge, confidence, and experience. Reflexive thematic analysis was used to identify patterns within the free text about participants' experiences. PARTICIPANTS Undergraduate midwifery students (n = 303) from Nursing and Midwifery Council-approved educational institutions within the United Kingdom. FINDINGS Most participants demonstrated good theoretical knowledge. They had witnessed the technique being used in clinical practice, and when performed, the practice was reported to be in line with national guidance. In closed questions, participants reported feeling confident in their intermittent auscultation skills; however, these data contrasted with free-text responses. CONCLUSION This cross-sectional survey found that student midwives possess adequate knowledge of intermittent auscultation. However, reflecting individual clinical experiences, their confidence in their ability to perform intermittent auscultation varied. A lack of opportunity to practice intermittent auscultation, organisational culture, and midwives' preferences have caused student midwives to question their capabilities with this essential clinical skill, leaving some with doubt about their competency close to registration.
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Affiliation(s)
- K Phillips
- School of Healthcare Sciences, Cardiff University, Room 0.43, Ground Floor, Ty'r Wyddfa, Heath Park West, St. Agnes Road, Cardiff CF14 4US, United Kingdom.
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Room 0.43, Ground Floor, Ty'r Wyddfa, Heath Park West, St. Agnes Road, Cardiff CF14 4US, United Kingdom
| | - L E Warren
- School of Healthcare Sciences, Cardiff University, Room 0.43, Ground Floor, Ty'r Wyddfa, Heath Park West, St. Agnes Road, Cardiff CF14 4US, United Kingdom
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Lamé G, Liberati EG, Canham A, Burt J, Hinton L, Draycott T, Winter C, Dakin FH, Richards N, Miller L, Willars J, Dixon-Woods M. Why is safety in intrapartum electronic fetal monitoring so hard? A qualitative study combining human factors/ergonomics and social science analysis. BMJ Qual Saf 2024; 33:246-256. [PMID: 37945341 PMCID: PMC10982615 DOI: 10.1136/bmjqs-2023-016144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/16/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Problems in intrapartum electronic fetal monitoring with cardiotocography (CTG) remain a major area of preventable harm. Poor understanding of the range of influences on safety may have hindered improvement. Taking an interdisciplinary perspective, we sought to characterise the everyday practice of CTG monitoring and the work systems within which it takes place, with the goal of identifying potential sources of risk. METHODS Human factors/ergonomics (HF/E) experts and social scientists conducted 325 hours of observations and 23 interviews in three maternity units in the UK, focusing on how CTG tasks were undertaken, the influences on this work and the cultural and organisational features of work settings. HF/E analysis was based on the Systems Engineering Initiative for Patient Safety 2.0 model. Social science analysis was based on the constant comparative method. RESULTS CTG monitoring can be understood as a complex sociotechnical activity, with tasks, people, tools and technology, and organisational and external factors all combining to affect safety. Fetal heart rate patterns need to be recorded and interpreted correctly. Systems are also required for seeking the opinions of others, determining whether the situation warrants concern, escalating concerns and mobilising response. These processes may be inadequately designed or function suboptimally, and may be further complicated by staffing issues, equipment and ergonomics issues, and competing and frequently changing clinical guidelines. Practice may also be affected by variable standards and workflows, variations in clinical competence, teamwork and situation awareness, and the ability to communicate concerns freely. CONCLUSIONS CTG monitoring is an inherently collective and sociotechnical practice. Improving it will require accounting for complex system interdependencies, rather than focusing solely on discrete factors such as individual technical proficiency in interpreting traces.
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Affiliation(s)
- Guillaume Lamé
- Laboratoire Génie Industriel, CentraleSupélec, Gif-sur-Yvette, France
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Elisa Giulia Liberati
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | | | - Jenni Burt
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Francesca Helen Dakin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Natalie Richards
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Lucy Miller
- University Division of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Janet Willars
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Mary Dixon-Woods
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
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Beaves M, Zoanetti N, Wallace EM, Palmer KR. Immediate and longer-term impacts of fetal surveillance education on workforce knowledge and cognitive skills. MEDEDPUBLISH 2023; 13:38. [PMID: 38779369 PMCID: PMC11109546 DOI: 10.12688/mep.19656.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 05/25/2024] Open
Abstract
Background: Following the development of the Royal Australian College of Obstetricians and Gynaecologists Intrapartum Fetal Surveillance Guideline in 2003, an education program was developed to support guideline implementation and clinical practice. It was intended that improved clinician knowledge, particularly of cardiotocography, would reduce rates of intrapartum fetal morbidity and mortality. The program contains a multiple-choice assessment, designed to assess fetal surveillance knowledge and the application of that knowledge. We used the results of this assessment over time to evaluate the impact of the education program on clinicians' fetal surveillance knowledge and interpretive skills, in the immediate and longer-term. Methods: We undertook a retrospective analysis of the assessment results for all participants in the Fetal Surveillance Education Program, between 2004 and 2018. Classical Test Theory and Rasch Item Response Theory analysis were used to evaluate the statistical reliability and quality of the assessment, and the measurement invariance or stability of the assessments over time. Clinicians' assessment scores were then reviewed by craft group and previous exposure to the program. Results: The results from 64,430, broadly similar assessments, showed that participation in the education program was associated with an immediate improvement in clinician performance in the assessment. Performance improvement was sustained for up to 18 months following participation in the program and recurrent participation was associated with progressive improvements. These trends were observed for all craft groups (consultant obstetricians, doctors in training, general practitioners, midwives, student midwives). Conclusions: These findings suggest that the Fetal Surveillance Education Program has improved clinician knowledge and the associated cognitive skills over time. The stable difficulty of the assessment tool means any improvement in clinician's results, with ongoing exposure to the program, can be reliably assessed and demonstrated. Importantly this holds true for all craft groups involved in intrapartum care and the interpretation of cardiotocography.
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Affiliation(s)
- Mark Beaves
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists, MELBOURNE, Victoria, 3004, Australia
- Dept of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, 3800, Australia
| | - Nathan Zoanetti
- Research, Australian Council for Educational Research, Camberwell, Victoria, 3124, Australia
| | - Euan M Wallace
- Dept of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, 3800, Australia
- Victorian Government, Department of Health, MELBOURNE, Victoria, 3000, Australia
| | - Kirsten R Palmer
- Dept of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, 3800, Australia
- Obstetrics and Gynaecology, Monash Health, Clayton, Victoria, 3168, Australia
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Romijn A, Bakker PCAM, Teunissen PW. Cardiotocography in practice: a qualitative study to explore obstetrical care professionals' experiences with using cardiotocography information in Dutch practice. BMJ Open 2023; 13:e068162. [PMID: 37321812 PMCID: PMC10277076 DOI: 10.1136/bmjopen-2022-068162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE This study aimed to explore obstetric care professionals' experiences with using cardiotocograph (CTG) information and how they employ this tool in their practice. DESIGN Qualitative study, involving 30 semi-structured interviews and two focus group sessions. Conventional content analysis was used for data analysis. SETTING Amsterdam University Medical Centers in the Netherlands. PARTICIPANTS In total, 43 care professionals participated. The respondents included obstetricians, residents in obstetrics and gynaecology, junior physicians, clinical midwives and nurses. FINDINGS Three main categories were identified that influenced the use of cardiotocography in practice; (1) individual characteristics involving knowledge, experience and personal beliefs; (2) teams involving collaboration in and between shifts and (3) work environment involving equipment, culture and continuing development. CONCLUSION This study underlines the importance of teamwork when working with cardiotocography in practice. There is a particular need to create shared responsibility among team members for cardiotocography interpretation and appropriate management, which should be addressed in educational programmes and regular multidisciplinary meetings, to allow learning from colleagues' perspectives.
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Affiliation(s)
- A Romijn
- Department of Obstetrics and Gynaecology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - P C A M Bakker
- Department of Obstetrics and Gynaecology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Cavoretto PI, Seidenari A, Farina A. Hazard and cumulative incidence of umbilical cord metabolic acidemia at birth in fetuses experiencing the second stage of labor and pathologic intrapartum fetal heart rate requiring expedited delivery. Arch Gynecol Obstet 2023; 307:1225-1232. [PMID: 35596749 PMCID: PMC10023766 DOI: 10.1007/s00404-022-06594-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/25/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The aim of the study was to determine the cause-specific hazard (CSH) and the cumulative incidence function (CIF) for umbilical cord metabolic acidemia at birth (MA; pH < 7.0 and/or BE [Formula: see text] - 12 mmol/L) at delivery in patients experiencing the 2nd stage of labor (2STG), stratified for both FIGO-2015 pathologic intrapartum cardiotocography requiring expedited delivery (CTG_RED) and duration of 2nd stage of labor. METHODS 3459 pregnancies experiencing the 2nd stage of labor and delivering at the Division of Obstetrics and Prenatal Medicine, IRCCS Sant'Orsola-Malpighi Hospital, Bologna (Italy), were identified between 2018 and 2019. Survival analysis was used to assess CSH and CIF for MA, stratified for FIGO-2015 pathologic CTG and relevant covariates. RESULTS FIGO-2015 pathological CTG with expedited operative delivery or urgent cesarean section within 10 or 20 min from diagnosis, respectively occurred in 282/3459 (8.20%). The rate of MA at delivery was 3.32% (115/3459). The spline of CSH for MA showed a direct correlation with the duration of 2STG always presenting higher values and greater slope in the presence of pathologic CTG, with plateau between 60 and 120 min and rapid increase after 120 min. The CIF at 180 min in the 2STG was 2.67% for nonpathological and 10.63% for pathological CTG_RED. Nulliparity, pathological CTG, and meconium-stained amniotic fluid resulted significant predictors of MA in our multivariable model. CONCLUSION The risk for MA increases moderately across the 2STG with nonpathological CTG and quadruples with pathological CTG_RED. Adjustment for other predictors of MA including meconium-stained amniotic fluid and nulliparity reveals a significant hazard increase for MA associated with pathologic CTG_RED.
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Affiliation(s)
- Paolo Ivo Cavoretto
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, University Vita-Salute, Milan, Italy
| | - Anna Seidenari
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy, University of Bologna, Via Massarenti 13, 40138, Bologna, Italy
| | - Antonio Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy, University of Bologna, Via Massarenti 13, 40138, Bologna, Italy.
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Sholapurkar SL. The round shape of a wheel and meta-analysis - rational review of training of intrapartum fetal monitoring and the importance of its content: Re: Kelly S, Redmond P, King S, Oliver-Williams C, Lame G, Liberati E et al. Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta-analysis. BJOG 2021; 128: 1408-1419. BJOG 2021; 129:671-672. [PMID: 34605144 DOI: 10.1111/1471-0528.16893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 11/28/2022]
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Lightly K, Weeks AD, Scott H. Re: Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta-analysis. Cardiotocography training is a complex intervention and requires complex evaluations. BJOG 2021; 128:1888-1889. [PMID: 34121310 DOI: 10.1111/1471-0528.16764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Kate Lightly
- Sanyu Research Unit, University of Liverpool and Liverpool Women's NHS Foundation Trust, Members of Liverpool Health Partners, Crown Street, Liverpool, L8 7SS, UK
| | - Andrew D Weeks
- Sanyu Research Unit, University of Liverpool and Liverpool Women's NHS Foundation Trust, Members of Liverpool Health Partners, Crown Street, Liverpool, L8 7SS, UK
| | - Hazel Scott
- School of Medicine, University of Liverpool, Cedar House, Liverpool, L69 3GE, UK
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Kelly S, Draycott T, Dixon-Woods M, Burt J. Re: Training in the use of intrapartum electronic fetal monitoring with cardiotocography: systematic review and meta-analysis: Response to letter to the editor: CTG training is a complex intervention and requires complex evaluations (Lightly K, Weeks AD, Scott H). BJOG 2021; 128:1889-1890. [PMID: 34089215 DOI: 10.1111/1471-0528.16757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah Kelly
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Tim Draycott
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Jenni Burt
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
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Noel-Storr AH, Redmond P, Lamé G, Liberati E, Kelly S, Miller L, Dooley G, Paterson A, Burt J. Crowdsourcing citation-screening in a mixed-studies systematic review: a feasibility study. BMC Med Res Methodol 2021; 21:88. [PMID: 33906604 PMCID: PMC8077753 DOI: 10.1186/s12874-021-01271-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Crowdsourcing engages the help of large numbers of people in tasks, activities or projects, usually via the internet. One application of crowdsourcing is the screening of citations for inclusion in a systematic review. There is evidence that a 'Crowd' of non-specialists can reliably identify quantitative studies, such as randomized controlled trials, through the assessment of study titles and abstracts. In this feasibility study, we investigated crowd performance of an online, topic-based citation-screening task, assessing titles and abstracts for inclusion in a single mixed-studies systematic review. METHODS This study was embedded within a mixed studies systematic review of maternity care, exploring the effects of training healthcare professionals in intrapartum cardiotocography. Citation-screening was undertaken via Cochrane Crowd, an online citizen science platform enabling volunteers to contribute to a range of tasks identifying evidence in health and healthcare. Contributors were recruited from users registered with Cochrane Crowd. Following completion of task-specific online training, the crowd and the review team independently screened 9546 titles and abstracts. The screening task was subsequently repeated with a new crowd following minor changes to the crowd agreement algorithm based on findings from the first screening task. We assessed the crowd decisions against the review team categorizations (the 'gold standard'), measuring sensitivity, specificity, time and task engagement. RESULTS Seventy-eight crowd contributors completed the first screening task. Sensitivity (the crowd's ability to correctly identify studies included within the review) was 84% (N = 42/50), and specificity (the crowd's ability to correctly identify excluded studies) was 99% (N = 9373/9493). Task completion was 33 h for the crowd and 410 h for the review team; mean time to classify each record was 6.06 s for each crowd participant and 3.96 s for review team members. Replicating this task with 85 new contributors and an altered agreement algorithm found 94% sensitivity (N = 48/50) and 98% specificity (N = 9348/9493). Contributors reported positive experiences of the task. CONCLUSION It might be feasible to recruit and train a crowd to accurately perform topic-based citation-screening for mixed studies systematic reviews, though resource expended on the necessary customised training required should be factored in. In the face of long review production times, crowd screening may enable a more time-efficient conduct of reviews, with minimal reduction of citation-screening accuracy, but further research is needed.
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Affiliation(s)
- Anna H Noel-Storr
- Cochrane Dementia and Cognitive Improvement Group, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK.
| | - Patrick Redmond
- NIHR ACL in General Practice, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - Guillaume Lamé
- Laboratoire Genie Industriel, CentraleSupélec, Université Paris-Saclay, 91190, Gif-sur-Yvette, France
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Elisa Liberati
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Sarah Kelly
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Lucy Miller
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- University Division of Anaesthesia at Addenbrooke's, University of Cambridge, Cambridge, UK
| | - Gordon Dooley
- Metaxis Ltd, Elmbank Offices, Main Road Curbridge, Witney, Oxfordshire, OX29 7NT, UK
| | - Andy Paterson
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Jenni Burt
- The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
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Affiliation(s)
- Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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