Abstract
Objectives: To explore staff views on their roles, skills and training to deliver high quality and local intrapartum services in remote and rural settings against national recommendations.
Design: Interview and postal survey.
Setting: A stratified representative sample of remote and rural maternity units in Scotland (December 2002 to May 2003).
Participants: Staff proportionally representative of professional groups involved in maternity care.
Results: Staff interviews took place at 11 units (response rate 93%). A subsequent postal survey included the interview sample and staff in a further 11 units (response rate 78%). Medical specialisation, workforce issues, and proposed regulatory evaluation of competencies linked to throughput raised concerns about the sustainability and safety of services, particularly for "generalists" in rural maternity care teams and for medical cover in small district general hospitals with large rural catchments. Risk assessment and decision making to transfer were seen as central for effective rural practice and these were influenced by rural context. Staff self-reported competence and confidence varied according to procedure, but noted service change appeared to be underway ahead of their preparedness. Self-reported competence in managing obstetric emergencies was surprisingly high, with the caveat that they were not independently assessed in this study. Staff with access to video conference technology reported low actual use although there was enthusiasm about its potential use.
Conclusions: Considerable uncertainties remain around staffing models and training to maintain maternity care team skills and competencies. Further research is required to test how this will impact on safety, appropriateness, and access and acceptability to rural communities.
Full Text
The Full Text of this article is available as a PDF (91.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Cronin C., Cheang S., Hlynka D., Adair E., Roberts S. Videoconferencing can be used to assess neonatal resuscitation skills. Med Educ. 2001 Nov;35(11):1013–1023. doi: 10.1046/j.1365-2923.2001.01055.x. [DOI] [PubMed] [Google Scholar]
- Farmer J. C., Baird A. G., Iversen L. Rural deprivation: reflecting reality. Br J Gen Pract. 2001 Jun;51(467):486–491. [PMC free article] [PubMed] [Google Scholar]
- Grzybowski S. C. Problems of providing limited obstetrical services to small, isolated, rural populations. Can Fam Physician. 1998 Feb;44:223-6, 230-3. [PMC free article] [PubMed] [Google Scholar]
- Mays N., Pope C. Rigour and qualitative research. BMJ. 1995 Jul 8;311(6997):109–112. doi: 10.1136/bmj.311.6997.109. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ramsay C. R., Grant A. M., Wallace S. A., Garthwaite P. H., Monk A. F., Russell I. T. Assessment of the learning curve in health technologies. A systematic review. Int J Technol Assess Health Care. 2000 Autumn;16(4):1095–1108. doi: 10.1017/s0266462300103149. [DOI] [PubMed] [Google Scholar]
- Tucker J., Farmer J., Stimpson P. Guidelines and management of mild hypertensive conditions in pregnancy in rural general practices in Scotland: issues of appropriateness and access. Qual Saf Health Care. 2003 Aug;12(4):286–290. doi: 10.1136/qhc.12.4.286. [DOI] [PMC free article] [PubMed] [Google Scholar]