Abstract
Background: The Respiration, Activity, Position, Perfusion, Temperature (RAPPT) tool was developed with the aim of reducing incidences of Sudden Unexpected Postnatal Collapse (SUPC) and term admissions to the neonatal unit (NNU). It is extensively documented that postnatal observations of the newborn are limited. The RAPPT tool was introduced to two local NHS trusts in 2020 and both saw a reduction in term admissions to the neonatal unit. Like any new initiatives,midwives and healthcare professionals should be understanding of the rationale behind the implementation, which does not always occur, changes can often be viewed as additional workload, putting a strain on an already stretched NHS
maternity service. Aim: The aim of this study was to explore midwives’ views and experiences using the RAPPT tool in clinical practice following its implementation, discussing whether and how the RAPPT tool has changed or impacted their clinical practice. Methodology: Descriptive qualitative research was applied utilising semi-structured interviews with five midwife participants, data was then analysed utilising thematic analysis. Findings and discussion: Four superordinate themes were identified: 1) Modern day maternity services: “well you know what it’s like”; participants highlighted challenges they faced in clinical practice, including increased demand for documentation and having “another piece of paper” to complete when balancing reduced staffing levels and stressful working environments. Participants reflected on staffing concerns stating: “there isn’t enough of us- we are always short” and ways this can potentially impact safety and clinical practice. 2) Communication, informed consent & ‘information overload’, findings suggest that midwives utilised the RAPPT tool to communicate concerns with the multidisciplinary team participants explained that the tool helps to “back us up” when escalating findings, however discrepancies arose between midwives of how they communicated with women to gain consent to utilise the tool with many reflecting that “women do just comply with what we are saying is best”. 3) Iatrogenic effects on clinical practice and patient safety, participants highlighted concern that despite the tool being designed to enhance patient safety, participants felt at times the tool was ‘jumping in’ too soon and had potential to interrupt a normal physiological transition to extrauterine life. Participants did however recognise that the tool has reduced term admissions to the NNU and the perceived the tool to reduce high utilisation of intravenous antibiotics. 4) The newly qualified midwife (NQM), participants suggest NQMs utilised the tool more robustly than senior colleagues, NQM’s were viewed to lack confidence in recognising signs of the deteriorating infant and therefore they were perceived to value the tool’s implementation more so than their senior colleagues. Conclusion and recommendation: Findings suggest that midwives value the RAPPT tool as a communication aid and recognise its ability to reduce term admissions to the NNU, recognising signs of the deteriorating infant before SUPC occurs. Findings suggest that midwives worry that its implementation may hinder care due to staffing issues, additional documentation and could possibly reduce autonomy for midwives and women. NQMs were viewed to use the tool more robustly than their senior colleagues. Further studies are required to analyse the RAPPT tool’s appropriateness for utilisation amongst all ethnicities including black and minority ethnic infants with adaptations required to meet this requirement. Longitudinal studies would assist to delve further into midwives’ views over a longer period, as attitudes and views may change from the point of implementation to when the tool is well established in practice
| Date of Award | 15 Mar 2024 |
|---|---|
| Original language | English |
| Supervisor | Jayne Samples (Main Supervisor) & Zoe Darwin (Co-Supervisor) |