Preparation of an Evidence-Based Clinical Guideline Informed by a Critique of Relevant Evidence - Assignment Example

RЕРАRАTIОN ОF АN ЕVIDЕNСЕ BАSЕD СLINIСАL GUIDЕLINЕ COURSE NAME STUDENT NAME STUDY LEVEL DATE Table of Contents Part 1 Introduction and discussion about importance and need of guidelines in midwifery. Purpose of this assessment (developing a guideline) Target audience of the guideline Rational of the guideline Expected benefits of the guideline Part 2 Critically appraise the 5 research articles, 1) A Systemic Review study 2) A Randomised Controlled study 3) A Quantitative study (also known as Cohort or population base studies) 4) And 2 Qualitative studies. Part 3 Key findings summarized Potential significance of findings on midwifery practice Recommendations for practice with supporting evidence Part 4 Strategies to implement the guideline Ways the guideline can be evaluated Conclusion Part 1 Introduction and discussion about importance and need of guidelines in midwifery. This is an assessment of programs involving the preparation of a clinical guideline for the midwifery practice of water birth. It does an analysis and comparison of the use of water immersion during the second stage of labour as compared to the option where immersion is not applied. This study finds the evidence based practice of midwifery in the current age very relevant as a method of reducing pain during the process of delivery. The study will go further into investigating the hypothesis that mothers prefer the use of water birth midwifery practice in child bearing as opposed to the analgesia. By statistical comparison, this method of midwifery is gaining more popularity. Part of the confirmation will also come from the study of weather the mothers prefer the immersion or there are conditions that compel them to select it. After collecting the evidence, it will be necessary to test them with an objective to identify strong and weak evidences and provide necessary recommendations. The usefulness of the guideline will be evaluated in various methods to ascertain whether is relevant in the present age of technology or there is a better method. Purpose of this assessment (developing a guideline) The purpose of the assessment of this guideline is to measure its capacity to articulate the needs of comfortable conditions for delivery to be used among expectant mothers. The main objective is to encourage mothers to develop a paradigm shift from the use of analgesia and to promote the water labour methods where mothers o not have birth complications (Hale, 2008). Studies have shown that through water birth, midwives are able to identify the physiological, spiritual and emotional needs of mothers. In essence, this guideline promotes the use of normal birth in order to reduce the number of mothers who develop serious complications during and after births (Cluett et al, 2004). Target audience of the guideline The target group of this assessment is the category of women who maternity hospitals have classified as healthy, since they do not have signs of complicated births (Hatem et al 2008). The guideline also seeks to encourage natural ways of monitoring birth conditions (Rafferty, 2008). It promoted the use of simple natural methods for example the use of fingers among midwives to test the hearth beats of the unborn babies. It also targets mothers whose pregnancies are at risks as a result of delivery complications, especially in delayed muscular reactions. The major stakeholders of the guidelines therefore are the mother in labour. They obtain direct benefits by enjoying a quick, painless and comfortable birth at lower cost than in the Caesarean Section. There are other stakeholders of the program such as the midwife nurses. They find it to be an easier method of predicting the labour timings (Campbell, 2004). The programme enables them to learn the ways of improving delivery services based on the recommendation of the assessment. The guideline teaches water birth; a method that reduces the delivery duration thus; it does not consume the nurses’ time (Gessbuhler et al, 2004). The child does not suffer suffocation during birth. Rational of theРRЕРАRАTIОN take holders. provides an informed point of view in practicing water birth midwifery as a method of child bearing. It gives reliable direction for effective application of mid wife services, which otherwise have experienced complicated problems in the past. It is an assurance of a very essential safety in child birth where mothers suffer from diabetes or other terminal illnesses. Such conditions may lead to major complications. The assessment eliminates the necessity of using pharmacological medicines to which mothers react in a variety of ways, some of which are fatal. While dispelling the chances of fatality, it reduces the cost of medical treatments and referrals during child bearing. According to Burns (2004), the duration of birth periods in water immersion has proved in many cases to be shorter than in traditional methods. It has a recommendable degree foreseeing labour and of measuring the length of labour period that leads to the beginning of birth process. The assessment has assisted in identifying special needs that call for careful attention among child bearing mothers (Garland, 2004). The major theme in this guideline is to discourage the mentality among mothers that Caesarean Section is the most painless method of child bearing regardless of its side effects. This assessment will assist in the establishment of the importance of evidence based water birth practices as well as the ways of improving the results of the guideline. The other rationale of the assessment is that it will also concentrate on investigating and discussing the benefits of the guideline and its66666666666666666666666666It will be able to verify the level of satisfaction among mothers in need of delivery by studying the statistics of mothers who show positive reactions towards water birth immersion. Expected benefits of the guideline The benefits of the evidence based guideline on mid wife water birth is a reduced costs of services as a result on minimal application of machines. The guideline enables mothers to realize the relevance of having natural births procedures as opposed to analgesia or anaesthesia. The two are usually applied in surgery, which leads to long term scars long after the birth, prompting unnecessary medical attentions that could be prevented (Cluett et al, 2004) and (Cluett et al, 2001). Mid wife water birth is a safe option. It provides them with information on the use of water pools. The guidelines work best when used during the antenatal stages to prepare the mothers in advance. It encourages mothers to who prefer using other methods to adopt this mid the wife practice quickly enough. The guideline presents them with the discretion to decide how they prefer to deliver (Plumb et al, 2007). This guideline provides a solution for endangered pregnancies that is safer than the Caesarean Section (CS) in child bearing. Part 2 critically appraise the 5 research articles 1) A Systemic Review study Article: “Clinical guidelines in nursing, midwifery and the therapies: a systematic review” from the University of New Castle (Hodnett, 2001). a. Domain 1: Methodology used This study did an evaluation of 18 guidelines dating from 1975 (Elvan-Taspinar et al, 2006). There were criteria set to identify the guidelines that met the professional practice requirement. The second method was the distribution of educational resources. b. Domain 2: Finding Active dissemination of guidelines finds the application of education intervention very useful, unlike passive dissemination. c. Domain 3: Strengths of the evidence Evidence was supported by multiple sources, mainly, professional education materials. It compared different strategies of implementation as well as dissemination. d. Domain 4: Weakness of the evidence Clinical guidelines were not able to minimize unsuitable disparity in practice in order to produce high quality services. The effectiveness of professionalism was not perfectly exhibited since there were no meticulous overviews. e. Domain 5: Recommendation This article requires rigorous overview to improve its professionalism and effectiveness. This will eventually lead to high quality services among the midwives. 2) A Randomized Controlled study Article: “A Randomized, Controlled Trial of Nurse-Midwifery Care” a. Domain 1: Methodology used A random controlled trial was used in a tertiary care hospital in order to determine the effectiveness of midwife program. b. Domain 2: Finding Low risks involved. The rate of Caesarean births reduced from 15% to 4 % (Miller, 2006). c. Domain 3: Strengths of the evidence The guideline was practical and effective in convincing the target group (Lindsey, 2006). The results showed a great support and positive response towards the pilot program. d. Domain 4: Weakness of the evidence Intervention of ultrasound and drugs were inevitably essential. Children stayed longer in the neonatal care units. e. Domain 5: Recommendation The article needs to do a review on the guidelines to find out how to reduce the duration of stay of the mother and child in the post natal wards. It also needs to find alternatives to medication, such as food supplements. 3) A Quantitative study (also known as Cohort or population base studies) Article: “Research Methods in Nursing and Midwifery: Pathways to Evidence-Based Practice”. a. Domain 1: Methodology used It used of critical thinking and cognitive skills to develop solutions to problems and decision making skills. b. Domain 2: Finding Data analysis results were consistent with the evidences collected from the random distribution (Stables & Rankin, 2005). Flow diagrams were effective in guiding students in effective decision making. c. Domain 3: Strengths of the evidence It is based on measurable parameters hence; it is reliable. d. Domain 4: Weakness of the evidence Some of the analytical ideas among students were prejudiced and manipulated to fit certain expectations (Otigba et al, 2000) and (Dooley, 2007). e. Domain 5: Recommendation This article should avoid over relying on critical thinking because they are not absolutely perfect. The good aspect of it is that it uses measurable parameters. 4) Qualitative study 1. Article: “A qualitative study exploring midwives' perceptions and views of extending their role to the examination of the newborn baby”. a. Domain 1: Methodology used It applied the collection of data through semi-structured and self-explanatory interviews. The interviews were interactive in nature. b. Domain 2: Finding Midwives were able to acquire information that could improve their competence. Customer satisfaction was realized because the nurses were available for longer periods to serve mothers and their children (Irvine & Shaw, 2007). c. Domain 3: Strengths of the evidence It was professional and practical since it was based on practical data, and interactive interviews. d. Domain 4: Weakness of the evidence It added more work for midwives and overburdened them. e. Domain 5: Recommendation The article necessitates an increase in the number of nurses required to work comfortably. It is however recommendable for the interactive nature. 5.) Qualitative study 2. Article: “Stressful Childbirth Situations: A Qualitative Study of Midwives” a. Domain 1: Methodology used It conducted a test among eighteen midwives assigned duties in six labor wards. Participants were taken through interviews to determine the extreme of stressful moments (Otigba et al, 2000). b. Domain 2: Finding Child birth situations full of stress can have permanent impact on the identity and professionalism of midwives. c. Domain 3: Strengths of the evidence It suggests ways of dealing with stressful moments of child birth, and hence, takes care of midwives’ emotions. d. Domain 4: Weakness of the evidence It prompts supervisory services for midwives, which is an added task. The workload increased on the part of midwives, hence it became burdensome. e. Domain 5: Recommendations The article should describe mechanisms that encourage self-supervisory attitude among midwives. It should also find more ways of dealing with stressful moments to make work easier for midwives. Part 3 Key findings summarized The findings of this assessment show that midwifery practice is the most advisable eveidence based approach of delivery (Sellar, 2008). Studies show that water birth is rapidly gaining popularity as a solution for threatened pregnancies. There is a common idea among mothers that this approach facilitates muscle relaxation and as a result, mothers can deliver with minimal assistance from the midwives (Burton & Steer, 2007). Potential significance of findings on midwifery practice The relevance of the findings of the midwifery practice to a larger extent depends on the opinions of the mid wives and the mothers using the immersion method of delivery. The relevance is not a matter that is generic to all cases, but to specific incidents because different mothers respond differently to methods of delivery. Secondly, it depends on the real evidences of benefits and risks involved (Winters & Duckett, 2006). If the risks involved are within the controllable limits, then the practice is relevant. For example, if there are unmanageable complications related to a particular case, then it may not be rational to apply it. On the other hand, if there is absolutely no complication and the comments of either the midwives or the mothers are positive, then the methods are relevant. The guide attempts to answer a few critical questions in relation to the child bearing using evidence based methods. One of the questions is whether there is a possibility of handling all labour conditions without any exception. Secondly, there is a question as to whether water birth can survive without the intervention of obstetricians. Finally, is there a way through which water birth can completely eliminate the need for Caesarean Operations? This is in the light of the mothers who fear the attempt to undergo the labour process under water immersion in the second labour stage. The guideline tends to answer the questions but still does not completely evade critiques from various corners. Recommendations for practice with supporting evidence The evidences of experiences of midwife water birth practices define the implementation of the guidelines. The recommendation gives priority to health and safety conditions of mothers during labour stages. It further relates the use of warm water immersion as a procedure to reduce blood pressure and hence; is a form of therapy for mothers. There recommendations solve the barriers to the implementation of the evidence based guideline. First, it is establishes the suitability of implementation among mothers who have in the past gone through Caesarean section. It confirms the risk of scars and raptures that can nullify the expected results. The recommendation further suggests the task of monitoring the process in the pool. The recommendations are important strategies in the implementation of the guideline (Balaskas, 2004). The strategy involves an assessment of the mothers’ conditions at the antenatal stage to identify any possible barrier to the guideline related to them. Part 4 Strategies to implement the guideline After reviewing recommendations of the present guideline based on the available evidences, it will be important to perform criteria evaluation to identify possible ways of improving the guideline. The guideline has to take into consideration the parameters such as comfort of the pool, the environmental conditions of the pool rooms and the performance of the taps (Zanetti-Daellenbach et al, 2007). Of course, the comments of the mothers who have passed through the method are symbols of live experiences that can easily be used either to criticize or endorse the method (Ohlsson et al, 2001). An example of positive comments is in an incident in the Cork University Maternity Hospital where a mother commented about the water as a wonderful experience of the pool room (Odent, 2000). The attitude of the midwives is another indicator of the need for improvement of the results of this guideline (Zanetti-Daellenbach et al, 2007). Where there is a negative comment, the guideline will recommend timely remedial control actions to mitigate the risks and dangers involved. An example is where the taps have contaminated water that can easily cause infection to the mother and the child (Simkin & Ancheta, 2005). The outcome of the guideline will use the evidence to recommend replacement of the water or the tap, whichever is causing the contamination. Complications that can lead to death are minimized in the process hence the child is safe. Ways the guideline can be evaluated The guideline implementation strategies are essential to the implementation of the guideline because they do predictions to the expected consequences of implementation of the guideline. It enables midwives and obstetricians to prepare in time for the maternity health services and make timely referrals in cases of emergencies. The strategies require periodic review in order to make necessary changes to the guidelines. Studies have discovered that women prefer immersion of water during delivery as it is an effective pain reliever. It discourages the option of analgesia. It also reduces pregnancy and delivery related complications. By statistics of Eckert et al (2001), 57 percent of women according to the Cochrane Collaborations in the year 2012 were satisfied by complete immersion. Conclusion The guideline improvement promotes water birth in child bearing as a pain relieving option. It also justifies the support for water birth as a cost reducing method. It recommends further improvements in the criticised areas by first setting up provisions for anomalies in the acceptance that birth water can apply to every child birth incident (Richmond, 2003). A good implementation of the guideline recommendations eliminates criticism of this guideline. It brings forth the benefits of a combination of multiple indicators for labour predictions rather than depending on a single indicator. This is in important in the accurate prediction of all forms of labour (Thoeni et al, 2005). References Balaskas, J. (2004). TheWater Birth Book. London, Thorsons. Burns, E. (2004). Water; what are we afraid of? Practicing Midwife. Burton, R & Steer, P. (2007). Waterbirth for women with GBS. A pipe dream? The Practising Midwife. Campbell, G. (2004). Critical incident analysis of water immersion, British journal of Midwifery 20(1),p.23-45. Cluett, E.R., Pickering R.M., Getliffe K & Saunders N.J. (2004). Randomised controlled trial of labouring in water with standard of augmentation for management of dystocia in first stage of labour. British Medical Journal, 2(3), p.29-34. Cluett, E. R., Nikodem, V. C., McCandlish, R. E. & Burns, E. E. (2004). Immersion in water in pregnancy, labour and birth. Cochrane Database of Systematic Reviews, 34 (3), p.34-36 Cluett, E. R., Pickering, R. M. & Brooking, J. I. (2001). An investigation into the feasibility of comparing three management options (augmentation, conservative and water) for nulliparae with dystocia in the first stage of labour. Midwifery, 3(4),p.45-56. Dooley D. (2007). Enabling women with diabetes to have a normal birth, Midwiffery Matters, 4(12),p.45-56 Eckert, K., Turnbull, D. & MacLennan, A. (2001). Immersion in water in the first stage of labor: a randomized controlled trial. Birth, 3(5),p.4-7. Elvan-Taspinar, A, Franx, A., Delprat, C., Bruinse, H.W. & Koomans, H. A. (2006). Water immersion in pre-eclampsia. American Journal for Obstetrics and Gynecology, 8(4). Garland, D. (2004). Water birth: An attitude to care, (2nd edn) Books for Midwives, New York, NY: Edinburgh. Gessbuhler, V., Stein, S. & Ebehard, J. (2004). Waterbirths compared with landbirths: An observational study of nine years, Journal of Prenatal Medicine,4(5), p.34-46. Hale, R. (2008). Equipment for birth, British journal of Midwifery. 6(7),p.3-7 Hatem, M., Sandall, J., Devane, D., Soltani, H. & Gates S. (2008). Midwife-led versus other models of care for childbearing women (Review). New Jersey, NY: Cochrane library. Hodnett, E.D. (2001). Continuity of caregivers for care during pregnancy and childbirth (Cochrane Review. The Cochrane Library, 4, 2003. Chichester, UK: John Wiley & Sons, Ltd. Irvine, L. & Shaw, R. (2007). The impact of obesity on obstetric outcomes, M/D/RS Midwifery Digest. Lindsey, P. (2006). Creating normality in a high-risk pregnancy. Sydney:Practising Midwife. Miller, J. B. (2006). All vi/omen in labour should have the choice of a water birth. British journal of Midwifery.7(5), p.42-48 Odent, M. (2000). A landmark in the History of Birthing Pools. MidwiferyToday. Ohlsson, G., Buchhave, P., Leandersson, U., Nordstrom, L., Rydhstrom, H. & Sjolin, I. (2001). Warm tub bathing during labor: maternal and neonatal effects. Acta Obstetricia et Gynecologica Scandinavica. Otigba, C. M., Dhanjal, M. K., Harmsworth, G. & Chard, T. (2000). A retrospective comparison of water births and conventional vaginal deliveries. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 8(3), p.3-6 Otigba, C.M. Dhanjal M.K., Harmsworth, G., & Chard, T (2000). A retrospective comparison of water births and conventional vaginal Birth. Melbourne: McGraw Hill. Plumb, J., Howell, D. Burton, R. & Steer, P. (2007). Waterbirth for women with GBS: a pipe dream? Practising Midwife. Rafferty, L. (2008). Time to make a splash: a literature review on the use of water for labour and birth to inform service provision, MIDIRS Midwifery Digest. Richmond, H. (2003). Women's experience of waterbirth, Practicing Midwife, 2(3),p.23-34. Sellar, M. (2008). The VBAC waterbirth experience in Fife', RCM Alidwives, 3(4), p.44-56. Simkin, P, & Ancheta, R. (2005). The Labor Progress Handbook, (2nd edn). Oxford: Blackwell Publishing. Stables, D. & Rankin, J. (2005). Physiology in Childbearing with Anatomy and Related Biosciences, (2nd edn), London: Elsevier. Thoeni, A., Zech, N., Moroder, L. & Ploner, F. (2005). Review of 1600 water births. Does water birth increase the risk of neonatal infection? The Journal of Maternal-Fetal & Neonatal Medicine 2(4), P.11-16. Winters, P. & Duckett, I. (2006). Like ducks to water'. obesity on obstet,3(4),p.13-17. Zanetti-Daellenbach, R. A., Tschudin, S., Zhong, X.Y., Holzgreve,W., Lapaire, O. & Hosli, I. (2007). Maternal and neonatal infections and obstetrical outcome in water birth. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 2(12), p.23 Zanetti-Dallenbach, R.A., Holzgreave, W. & Hosli, I. (2007).Neonatal group B streptococcus colonization in waterbirths. International journal of Gynaecology and Obstetrics,7(2),p.16-19. Read More