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Clinical competencies and gestational diabetes in Ireland

Yvonne Maloney

RAMP Diabetes

Diabetes in pregnancy care (type 1 diabetes, type 2 diabetes and Gestational diabetes) is now an increasing requirement for nurses and midwives both nationally and internationally.

Gestational diabetes is defined as any degree of glucose intolerance, usually with first recognition, during pregnancy, after 24 weeks gestation.

The prevalence of gestational diabetes comes from the Atlantic DIP study of 5,000 women showing a prevalence rate of 12.4%. This prevalence rate is in keeping with the international literature which quotes a prevalence of 17%.

New recommendations on the diagnosis of gestational diabetes are now supported internationally. For example by the WHO, EASD, FIGO, EBCOG, Endocrine society and ADA. These changes in diagnostic criteria have in fact contributed to the increase in diabetes related care in Maternity hospitals.

Diabetes in pregnancy categorises women into the high risk group, requiring specialised care.
National Maternity Strategy.

Diabetes is associated with an increased risk of complications in pregnancy. For instance, congenital anomalies, miscarriage, stillbirth, preterm delivery, shoulder dystocia, caesarean section, short and long term infant metabolic disorders and development of long term maternal diabetes.

In the longer term, children born to mothers with diabetes are at greater risk of obesity and type 2 diabetes in later life. Similarly , this is related to effects of intrauterine exposure to hyperglycaemia.

The principles of Advanced Midwifery RAMP & Nursing Practice RANP are:

Respect for the Dignity of the Person

Midwifery practice is underpinned by a philosophy that protects and this in turn promotes the safety and autonomy of the woman. This also respects her experiences, choices, priorities, beliefs and values. As a result, the Respect for the Dignity of the Person under the care of the RANP includes demonstrating leadership in the promotion of safety and respect of individual autonomy and each person’s right to self-determination.

Professional Responsibility and Accountability

Midwives practise in line with legislation and professional guidance and are responsible and accountable within their scope of midwifery practice. This encompasses the full range of activities of the midwife as set out in EC Directive 2005/36/ EC and the adapted Definition of the Midwife International Confederation of Midwives 2011 (ICM) as adopted by the NMBI. Professional Responsibility and Accountability underpins the practice of the RANP who demonstrates high standards of professional behaviour. It is professionally responsible and accountable for his/her attitudes and actions including inactions and omissions. For this reason, the RANP recognises the relationship between professional responsibility and accountability and professional integrity whilst advocating for patients’ rights.

Quality of Practice

Midwives use comprehensive professional knowledge and skills to provide safe, competent, kind, compassionate and respectful care. For this reason, midwives keep up to date with midwifery practice by undertaking relevant continuing professional development.  Quality of Practice for RANPs is demonstration of leadership in the delivery of autonomous nursing practice based on expert knowledge, competence, kindness and compassion. RANPs promote the provision of quality care that ensures effective patient outcomes in safe environments.

Trust and Confidentiality

Midwives work in equal partnership with the woman and her family and establish a relationship of trust and confidentiality. Trust and Confidentiality are core professional values underpinning RANPs’ relationships with patients and colleagues, exercised through professional judgement and responsibility.

Collaboration with Others

Midwives communicates and collaborates effectively with women, women’s families and with the multidisciplinary healthcare team. As an illustration, collaboration with Others is integral to advanced practice (nursing) as RANPs demonstrate leadership in collaborating and communicating with various members of the multidisciplinary team in their quest for optimal patient outcomes.

Competencies required by the Advanced Practitioner in Ireland include:

  • Using advanced assessment and intervention strategies;
  • Using research when making clinical decisions;
  • Analysing complex interactions;
  • Guiding decision-making;
  • Developing client focused care.

Registered Advanced Nurse Practitioners RANPs and Registered Advanced Midwife Practitioners RAMPs are well placed to provide Diabetes in Pregnancy care in Ireland as autonomous practitioners under the clinical supervision of Consultant Endocrinologists and Consultant Obstetricians while they are under the professional and operational supervision of Senior Nursing and Midwifery Managers in the hospital groups.

The main advantages to Advanced Practice Nursing and Midwifery posts.

are their abilities to provide the following care to women with Diabetes in Pregnancy:

  • Diagnose diabetes and diabetes related conditions  
  • Order investigations  
  • Prescribe and educate the patient to titrate treatments e.g. Insulin  
  • Refer patients to other disciplines
  • Admit patients to hospitals as required   
  • Discharge patients home in a timely fashion  
  • Escalate areas of concern re patient care to their clinical supervisors e.g. Consultant Endocrinologists /Obstetricians
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