ABSTRACT
Obstetric triage is a rapidly growing area of obstetric care where most pregnancy complaints are evaluated starting at 20-24 weeks' gestation. This renewed interest in establishing obstetric triage units and using advanced practice nurses as care providers has heightened the visibility of obstetric triage for administrators and practitioners alike. This article reviews the history of obstetric triage, the role dimensions of advanced practice nurses in triage (specifically midwives), the increased clinical risks associated with obstetric triage, risk reduction strategies, and obstetric triage practice trends and liability issues in the future.
Subject(s)
Nurse Clinicians/organization & administration , Nurse Midwives/organization & administration , Obstetric Nursing/organization & administration , Pregnancy Complications/nursing , Triage/organization & administration , Female , Humans , Infant, Newborn , Job Description , Mass Screening/methods , Nursing Assessment/methods , PregnancyABSTRACT
Obstetric triage services are rapidly advancing, and the concept is becoming a popular practice pattern. As more pregnant women are evaluated in ambulatory settings, especially in high volume obstetric tertiary centers, it is now realized more and more that labor and other complaints cannot be addressed solely in labor and delivery units, nor are most of these complaints solely labor related. This article presents the results of a national survey designed to discover what contributions nurse-midwives are making to obstetric triage services. In addition, the results provide initial benchmark data on obstetric triage components against which other midwifery services can address practice issues.
Subject(s)
Delivery Rooms , Nurse Midwives , Triage/organization & administration , Female , Humans , Patient Admission , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/nursing , Triage/statistics & numerical data , United StatesABSTRACT
Acute, nonobstetric abdominal pain is a common complaint during pregnancy. Both anatomic and physiologic variations in pregnancy cloud the clinical picture when attempts at clinical decision-making and triage are made. Abdominal disorders such as appendicitis, gallbladder disease, pancreatitis, bowel obstruction, liver disease, pyelonephritis, and inflammatory bowel disease are explored from an obstetric triage perspective. Key triage points are noted to augment clinical assessment by the practitioner.
Subject(s)
Abdominal Pain/nursing , Pregnancy Complications/nursing , Triage/methods , Abdominal Pain/etiology , Acute Disease , Adult , Diagnosis, Differential , Female , Humans , Midwifery/methods , Nursing Diagnosis/methods , Pregnancy , Pregnancy Complications/etiologyABSTRACT
The health care industry is in the throes of remarkably penetrating and destabilizing change, the effects of which have been felt earliest by perinatal service directors. In anticipation of future trends marked by rampant change, a survey of perinatal service directors and vice presidents was conducted to elicit their opinions about the current and future states of perinatal health care. Findings supported the notions that change is a constant, that clinical and service excellence is a mandate, and that collaboration is key. Future success will require many old behaviors and systems to be replaced. Leadership to guide us to the future has never been more important.
Subject(s)
Attitude of Health Personnel , Health Care Reform/organization & administration , Neonatal Nursing/organization & administration , Nurse Administrators/psychology , Forecasting , Humans , Infant, Newborn , Job Description , Organizational Innovation , Surveys and Questionnaires , United StatesABSTRACT
Within the perinatal literature, there are few reports regarding obstetric triage. The documented use of advanced practice nurses performing obstetric triage is noted in some centers. The article documents the use of nurse-midwives in performing obstetric triage in an academic tertiary facility. Selected clinical scenarios are presented, and clinical management skills are delineated.
Subject(s)
Academic Medical Centers , Clinical Competence , Nurse Midwives , Pregnancy Complications/nursing , Triage , Decision Trees , Diagnosis, Differential , Female , Humans , Pregnancy , Pregnancy Complications/diagnosisABSTRACT
Academic nurse-midwifery services have shown themselves to be strong collaborators with medical education. The development and functioning of an academic nurse-midwifery service program built on a partnership model between medicine and midwifery are highlighted. Organizational relationships, philosophical approach, and practice dimensions including responsibilities for clinical practice, medical student, and obstetrical resident education are explored. As the obstetrical patient pool diminishes in academic service settings, this model may prove useful.
Subject(s)
Faculty, Nursing , Internship and Residency , Interprofessional Relations , Nurse Midwives , Obstetrics/education , Models, Organizational , Program DevelopmentABSTRACT
Mentoring in the career development of hospital staff nurses was explored using a qualitative, grounded-theory method in a descriptive study design. Verbatim audiotaped interviews of hospital staff nurses and their nurse managers from four hospitals in the northeast were used. Document analysis of key hospital and nursing organizational policy statements was included. Two models were identified from the study regarding the mentoring of hospital staff nurses, ie, a structural and a process model. Within the structural model, mentoring influentials were noted to be people, events, and environments. Peers and nurse managers proved to be the primary people influential in providing key mentoring strategies. Within the process model, four phases were identified leading to three separate career development outcomes toward which hospital staff nurses strive: the development of career-building relationships, facilitation of career transition points, and positive interaction within the organizational climate.
Subject(s)
Mentors , Models, Educational , Nursing Staff, Hospital , Staff Development/methods , Female , Humans , Interviews as Topic , Sex Factors , United StatesABSTRACT
The role of the nurse-midwife in a busy obstetric hospital is explored. This report reviews the role and development of this service and teaching program in a high volume obstetric service. The relationship among the nurse-midwives, residents, and faculty demonstrates the ability of these services to work effectively with a high-risk population. The occasional complication in the obstetric patient as seen in this study dictates a close working relationship within the hospital environment. With the ever increasing demands being placed on obstetric care, a strong working relationship among health care professionals is essential.
