The Study Of Prescription Content Of Midwife In Particular Situation

Purpose:After referring a great number of materials and analyzing the implementation of prescription right of nurse in other countries,this paper,according to Chinese real situation,will probe into the content and form of Chinese midwives prescription right in particular situations,as well as their working scope so as to provide scientific references and theory for China to legislate related laws and policies.Object:The standard of selecting expert is: 1)has the vice-senior professional title or above.2)worked in midwifery field with some practical experience for more than10 years.3)has a bachelor degree or above.4)has rigorous attitude and is willing to answer the expert questionnair.We carried two rounds of expert consultation aiming at 18 midwives and 14 obstetricians from many top three hospitals in China.Methods:1.Literature analysisWe made the expert questionnaire based on lots of literature reviews.2.Semi-structured interviewWe had the semi-structured interview with clinical workers.The first round of expert consultation questionnaire had been formed by performing analysis about the advice of clinical workers.3.Delphi methodsBy using Delphi methods,we carried two rounds of expert consultation aiming at 18 midwives and 14 obstetricians from many top three hospitals in China.The content of thequestionnaire included the particular situations,contents,forms of midwives prescription right and the working scope of midwives.Then we got research results by performing statistical analysis about the advice and information of experts.4.Statistical methodsWe performed statistical analysis about cousulting suggestion by using Microsoft Excel and SPSS22.0.Then wo got means,variable coefficient and standard deviation.Besides,we counted the approval rate of expert,enthusiasm coefficient of expert,the authority coefficient of expert and the coordination coefficient of expert.And we performed significance test about coordination coefficient by using SPSS22.0.Results:Through two rounds of experts consultation,this paper determine six situations in which midwives have rights to prescribe 20 medicine prescriptions and 13 auxiliary examination prescriptions.51.5% of them are tend to the form of independent prescription,30.3% of them are tend to the form of agreement prescription,18.2% of them are similar in above two forms.And we determine 17 items of midwives’ working scope.In detail,the six situations in which midwives have rights to prescribe are: uterine atony,metrypercinesia,postpartum hemorrhage,premature rupture of membranes,normal labor,and neonatal asphyxia.The prescribing contents and forms in these six conditions as follows:Tend to the form of independent prescription: midwives’ prescribing contents are as following: 1)Uterine atony : Glucose Injection+Vitamin C and fetal heart monitoring;2)Metrypercinesia: fetal heart monitoring;3)Postpartum hemorrhage: Oxytocin,Ringer’s solution,blood routine examination and coagulation function test;4)Premature rupture of membranes: Oxytocin,fetal heart monitoring and blood routine examination;5)Normal labor: Lidocaine,Vitamin K1,fetal heart monitoring,B ultrasonic examination and electrocardiography(ECG);6)Neonatal asphyxia: arterial blood gas analysis and blood glucose monitoring.Tend to the form of agreement prescription,midwives’ prescribing contents are as following: 1)Uterine atony: Diazepam;2)Metrypercinesia: Magnesium sulfate and Pethidine;3)Postpartum hemorrhage: Misoprostol;4)Premature rupture of membranes:Antibiotics and amniotic cavity infection monitoring;5)Normal labor: Pethidine and Metoclopramide;6)Neonatal asphyxia: Naloxone and Adrenaline.When these two forms are both available,midwives’ prescribing contents are as follows: 1)Uterine atony: Oxytocin,Ergonovine and blood biochemical examination.2)Postpartum hemorrhage: Hemabate,Ergonovine and electrolyte examination.17 items of midwives’ working scope are as follows: pregnancy-knowledge education;antenatal consultation,examination and monitoring;the management of nutrition in pregnancy;the management of prevent miscarriage;normal delivery;doula delivery;using no medicine to reduce pain during normal delivery;episiotomy and suture;monitoring condition of losing blood in puerpera;observing condition of wound and perineum,blood and lochia in puerpera;normal newborn nursing;scientific lactation education;health knowledge education in puerperium;telephone follow-up;review in postpartum 42 days.In the research,the authority coefficient is 0.915.The coordination coefficient of expert are 0.207 and 0.489 of the two rounds of experts consultation about particular situations.The coordination coefficient of expert are 0.057 and 0.131 of the two rounds of experts consultation about midwives’ working scope.All coordination coefficient are between zero and one.The result of significance test is P<0.05.The authoritativeness of experts is high and the advice of experts are in harmony.The research results are dependable.Conclusion:In order to provide better service for mother and baby nursing,promote the professionalism and autonomy of midwifery profession and expand the number of midwifery,China should endow qualified midwives some prescribing rights in condition of uterine atony,metrypercinesia,postpartum hemorrhage,premature rupture of membranes,normal labor,neonatal asphyxia and make a clear definition for the working scope of midwives.Besides,the authoritativeness of the experts who participated in the consultation is high and the advice of experts is in harmony.The research results are dependable.