The eligibility criteria, training content, and scope of practice for prescriptive authority for midwives: a modified Delphi study†
, , , oraz | 07 lis 2019
O artykule
Article Category: Original article
Data publikacji: 07 lis 2019
Zakres stron: 191 - 201
Otrzymano: 02 gru 2018
Przyjęty: 23 lut 2018
DOI: https://doi.org/10.2478/FON-2019-0035
Słowa kluczowe
© 2019 Shi-Fan Han et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.
The consensus on the minimum acceptable eligibility criteria for prescriptive authority for midwives (n = 34)
| Eligibility criteria | Number of nursing experts | Number of medical experts | Total number of experts | Acceptance rate (%) | |
|---|---|---|---|---|---|
| Junior college | 3 | 1 | 4 | 11.76 | |
| Undergraduate | 13 | 11 | 24 | 70.59 | |
| Master’s | 4 | 2 | 6 | 17.65 | |
| Supervisor nurse practitioner | 18 | 11 | 29 | 85.29 | |
| Co-chief superintendent nurse | 2 | 2 | 4 | 11.76 | |
| Chief superintendent nurse | 0 | 1 | 1 | 2.94 | |
| Junior college | 7 years | 2 | 1 | 3 | 8.82 |
| 8 years | 1 | 0 | 1 | 2.94 | |
| Undergraduate | 5 years | 11 | 6 | 17 | 50.00 |
| 6 years | 0 | 1 | 1 | 2.94 | |
| 7 years | 2 | 3 | 5 | 14.71 | |
| 8 years | 0 | 1 | 1 | 2.94 | |
| Master’s | 3 years | 3 | 2 | 5 | 14.71 |
| 4 years | 1 | 0 | 1 | 2.94 | |
| Grade B hospital | 2 | 1 | 3 | 8.82 | |
| Grade C hospital | 18 | 13 | 31 | 91.18 |
Survey on the scope of practice of prescriptive authority for midwives in specific conditions
| Round of survey | Ca | Cs | Cr |
|---|---|---|---|
| Round one | 0.94 | 0.89 | 0.915 |
| Round two | 0.94 | 0.89 | 0.915 |
Statistics on the acceptance of conditions for midwives practicing prescriptive authority (Round 1)
| Specific condition | Total | Minimum | Maximum | Average | Standard deviation | Coefficient of variation |
|---|---|---|---|---|---|---|
| Induced labor | 32 | 1.00 | 5.00 | 3.844 | 1.221 | 0.318 |
| Uterine atony | 32 | 3.00 | 5.00 | 4.375 | 0.751 | 0.172 |
| Excessive uterine contraction | 32 | 2.00 | 5.00 | 4.094 | 0.893 | 0.218 |
| Postpartum hemorrhage | 32 | 2.00 | 5.00 | 4.125 | 0.793 | 0.192 |
| Premature rupture of fetal membranes | 32 | 2.00 | 5.00 | 3.906 | 0.893 | 0.229 |
| Intrapartum fever | 32 | 1.00 | 5.00 | 3.000 | 1.295 | 0.432 |
| Gestational hypertension | 32 | 1.00 | 5.00 | 2.719 | 1.170 | 0.431 |
| Amniotic fluid embolism | 32 | 1.00 | 5.00 | 2.250 | 1.078 | 0.479 |
| Normal labor | 32 | 4.00 | 5.00 | 4.844 | 0.369 | 0.076 |
Scope of practice of prescriptive authority for midwives in specific conditions
| Specific condition/Scope of practice | Prescription forms |
|---|---|
| 5% glucose + vitamin C, fetal heart rate monitoring | Independent prescription |
| Diazepam | Protocol prescription |
| Oxytocin, ergometrine, blood biochemical test | Independent/protocol prescription |
| Magnesium sulfate, pethidine | Protocol prescription |
| Fetal heart rate monitoring | Independent prescription |
| Oxytocin, equilibrium liquid, routine blood test, and coagulation function test | Independent prescription |
| Misoprostol | Protocol prescription |
| Ergometrine, carboprost tromethamine, electrolyte test | Independent/protocol prescription |
| Oxytocin, fetal heart rate monitoring, routine blood test | Independent prescription |
| Antibiotics, amniotic cavity infection screening | Protocol prescription |
| Lidocaine, oxytocin, vitamin K1, fetal heart rate monitoring, B ultrasound, electrocardiographic examination | Independent prescription |
| Pethidine, metoclopramide | Protocol prescription |
| Blood oxygen analysis, blood sugar monitoring | Independent prescription |
| Epinephrine, naloxone | Protocol prescription |
Statistics on the acceptance of conditions for midwives practicing prescriptive authority (Round 2)
| Specific condition | Total | Minimum | Maximum | Average | Standard deviation | Coefficient of variation |
|---|---|---|---|---|---|---|
| Uterine atony | 30 | 4.00 | 5.00 | 4.600 | 0.498 | 0.108 |
| Excessive uterine contraction | 30 | 3.00 | 5.00 | 4.467 | 0.571 | 0.128 |
| Postpartum hemorrhage | 30 | 4.00 | 5.00 | 4.667 | 0.479 | 0.103 |
| Premature rupture of fetal membranes | 30 | 3.00 | 5.00 | 4.333 | 0.661 | 0.152 |
| Normal labor | 30 | 4.00 | 5.00 | 4.900 | 0.305 | 0.062 |
| Neonatal asphyxia | 30 | 3.00 | 5.00 | 4.300 | 0.596 | 0.138 |
Study on the eligibility criteria and training content for prescriptive authority for midwives
| Round of survey | Ca | Cs | Cr |
|---|---|---|---|
| Round one | 0.91 | 0.83 | 0.87 |
| Round two | 0.94 | 0.86 | 0.90 |
Basic information on the experts participating in the survey on scope of practice of prescriptive authority for midwives in specific conditions
| Status/experience | Medical profession | Nursing profession | Total | Percentage (%) |
|---|---|---|---|---|
| <40 | 1 | 1 | 2 | 6.3 |
| 40–45 | 6 | 5 | 11 | 34.4 |
| 46–50 | 3 | 5 | 8 | 28.1 |
| >50 | 4 | 7 | 11 | 31.2 |
| 15–20 | 3 | 2 | 5 | 15.6 |
| 21–25 | 4 | 4 | 8 | 25.0 |
| 26–30 | 3 | 5 | 8 | 25.0 |
| >30 | 4 | 7 | 11 | 34.4 |
| Undergraduate degree | 4 | 17 | 21 | 65.6 |
| Master’s | 9 | 0 | 9 | 28.1 |
| Doctorate | 1 | 1 | 2 | 6.3 |
| Medium rank | 4 | 7 | 11 | 34.4 |
| Associates | 7 | 10 | 17 | 53.1 |
| Senior | 3 | 1 | 4 | 12.5 |
| Hospital director/deputy director | 0 | 1 | 1 | 3.1 |
| Department director | 3 | 0 | 3 | 9.4 |
| Head nurse | 0 | 15 | 15 | 46.9 |
The consensus on the training topics for prescriptive authority for midwives (n = 34)
| Course content | Number of nursing experts | Number of medical experts’ care | Total number of experts | Acceptance rate (%) |
|---|---|---|---|---|
| Dosage calculation | 20 | 14 | 34 | 100 |
| Issues and countermeasures for drug compliance | 19 | 12 | 31 | 91.18 |
| Drug abuse | 19 | 13 | 32 | 94.12 |
| Drug safety and administration | 18 | 10 | 28 | 82.35 |
| Knowledge of OTC (over-the-counter) medicine | 19 | 13 | 32 | 94.12 |
| Drug use in obstetrics | 18 | 11 | 29 | 85.29 |
| Functions and responsibilities of midwives in medicinal treatments | 17 | 10 | 27 | 79.41 |
| Maternal and fetal evaluation | 19 | 10 | 29 | 85.29 |
| Medical history collection | 16 | 9 | 25 | 73.53 |
| Prenatal care | 18 | 9 | 27 | 79.41 |
| Maternal and fetal monitoring | 20 | 12 | 32 | 94.12 |
| Law and ethics in medicinal treatments | 20 | 13 | 33 | 97.06 |
| Prescription administration | 18 | 13 | 31 | 91.18 |
| Medical malpractice management regulation | 17 | 13 | 30 | 88.24 |
| Prescription types and prescribing decision framework | 19 | 11 | 30 | 88.24 |
| Formulation and writing of prescription | 20 | 12 | 32 | 94.12 |
| Effective communication with patients | 18 | 10 | 28 | 82.35 |
| Effective communication with physician in charge | 18 | 10 | 28 | 82.35 |
| Occupational (prescriptive) responsibility and obligation | 17 | 10 | 27 | 79.41 |
| Collaborative prescribing with physicians | 16 | 12 | 28 | 82.35 |
| Maternal physiology in pregnancy | 17 | 14 | 31 | 91.18 |
| Pregnancy diagnostics | 17 | 14 | 31 | 91.18 |
Basic information on the experts participating in the survey on eligibility criteria and training content for prescriptive authority for midwives
| Status/experience | Nursing expert | Medical expert | Total | Percentage (%) |
|---|---|---|---|---|
| <40 | 2 | 1 | 3 | 8.8 |
| 40–45 | 5 | 4 | 9 | 26.5 |
| 46–50 | 7 | 5 | 12 | 35.3 |
| >50 | 6 | 4 | 10 | 29.4 |
| 15–20 | 3 | 2 | 5 | 14.7 |
| 21–25 | 4 | 3 | 7 | 20.6 |
| 26–30 | 7 | 5 | 12 | 35.3 |
| >30 | 6 | 4 | 10 | 29.4 |
| Undergraduate degree | 16 | 2 | 18 | 52.9 |
| Master’s | 4 | 7 | 11 | 32.4 |
| Doctorate | 0 | 5 | 5 | 14.7 |
| Medium rank | 17 | 7 | 24 | 70.6 |
| Associates | 2 | 5 | 7 | 20.6 |
| Senior | 1 | 2 | 3 | 8.8 |
| Hospital director/ deputy director | 0 | 1 | 1 | 2.9 |
| Department director | 0 | 4 | 4 | 11.8 |
| Nursing department director | 1 | 0 | 1 | 2.9 |
| Head nurse | 7 | 0 | 7 | 20.6 |
The consensus on the training courses for prescriptive authority for midwives (n = 34)
| Course | Number of nursing experts | Number of medical experts | Total number of experts | Acceptance rate (%) |
|---|---|---|---|---|
| Pharmacology | 20 | 14 | 34 | 100.00 |
| Diagnostics | 20 | 12 | 32 | 94.12 |
| Law and ethics | 20 | 14 | 34 | 100.00 |
| Introductory course | 20 | 13 | 33 | 97.06 |
| Midwifery | 18 | 14 | 32 | 94.12 |
Survey for confirming the scope of practice of prescriptive authority for midwives in specific conditions
| Round of survey | Number distributed | Number of surveys responded to | Number of invalid responses | Response rate (%) |
|---|---|---|---|---|
| Round one | 36 | 32 | 4 | 88.89 |
| Round two | 32 | 30 | 2 | 93.75 |
Survey on the eligibility criteria and training content for prescriptive authority for midwives
| Round of survey | Number of surveys distributed | Number of surveys responded to | Number of invalid responses | Response rate (%) |
|---|---|---|---|---|
| Round one | 40 | 36 | 4 | 90 |
| Round two | 36 | 36 | 0 | 100 |