The Order of Nurses (OE) points out “inaccuracies, gaps and flaws” to the Hospital Referral Network in Obstetrics, Gynecology and Neonatology, considering the non-inclusion of these professionals in the group of experts who prepared the proposal to be serious.
In a position issued as part of the public consultation of the document, which has been taking place since the beginning of the month, the OE regrets the fact that the working group did not include any member of the profession’s regulatory body.
This option, “centered on an essentially medical vision”, does not allow “the integration of the knowledge and experience of the largest professional health group present in the services in question” and “leads to the serious gaps identified in the document”, considers the OE, stressing that the elaboration of “a structuring document” for the health system without the inclusion of the Ordem dos Enfermeiros and the competent nursing specialty colleges “reduces, conditions and creates an important bias regarding the objective set”.
The OE says that the document, prepared by the working group coordinated by the doctor Diogo Ayres de Campos, director of the Gynecology and Obstetrics Service at Hospital de Santa Maria, presents “a reductive view” of nurses and Specialist Nurses in Maternal Health Nursing and Obstetrics (EEESMO) and Specialists in Child and Pediatric Health Nursing (EEESIP).
“The non-inclusion of nurses is particularly serious and results in inaccuracies, gaps and failures with regard to the identification of needs, allocations and implications regarding nursing care, crucial in providing an adequate response to the health needs of women, children and families”, he considers.
In the position taken, to which Lusa had access, the OE considers that, as the profession’s regulator, it is incumbent upon it to pronounce on “the determination of nursing care, allocation, technical-scientific requirements and conditions, including the definition in terms of ratios for its provision” and insists that a working group constituted “outside the national regulator” cannot “pronounce or determine the issues raised”.
In this way, it emphasizes that the determination of nurses in the document, as well as the reference to the time (FTE) that is presumed necessary for the provision, “constitutes a serious interference” in a matter of its competence.
“Someone who does not have legal and professional qualifications to practice nursing, or knowledge of the profession, cannot issue such determinations, under penalty of seriously impacting the quality and safety of the health care provided”, emphasizes the OE.
It recognizes that the document addresses the need to agree with the professional orders “standard teams of doctors, specialist nurses and generalist nurses for the emergencies of Obstetrics and Gynecology/Birth Block”, but underlines that, “in its genesis and content”, the proposal “contradicts the principles of agreement and teamwork”.
Regarding maternal and obstetrical health nursing care, the OE points out “the absence of any reference to consultations and other pre- and postpartum nursing interventions”, which it considers fundamental.
“The Order of Nurses, in view of what has been verified, cannot fail to express its opposition to a document that is intended to structure the provision of health care and in which non-nurses seek to determine what nurses do and how many are needed for the do”, he adds, recommending a revision of the document, “integrating the different dimensions of nursing”.
Concentration of obstetric urgencies “does not imply closures”
The nurses’ criticisms arise in reaction to the proposal by the Commission for Monitoring the Emergency Response in Gynecology/Obstetrics and the Delivery Block — created last summer to find solutions to the shortage of specialist doctors in public hospitals — on the reorganization of hospital services for Obstetrics and Gynecology. The group of experts defends, in turn, that the concentration of urgencies would not imply the closure of services or the end of the programmed activity.
In the proposal for a Hospital Referral Network in Obstetrics, Gynecology and Neonatology, which is in public consultation and which was criticized by the Order of Nurses, the specialists who proposed the concentration of six emergencies in Obstetrics and Gynecology/Birth Block in the North, Center and of Lisbon and Vale do Tejo argue that this measure “would not imply the closure of services nor the cessation of scheduled activity in obstetrics and gynecology in the targeted hospitals”.
Admitting that the concentration of some emergencies in Obstetrics and Gynecology/Birth Block “seems to be the only way to quickly ensure some stability of response in this area”, the experts write that this concentration would mean that activities related to the emergency, childbirth, puerperium and neonatal care “were relocated to another institution”.
In the document, they also explain that health professionals from the targeted hospitals would need to agree with the institution “to provide the weekly emergency activity elsewhere”, but underline that the remaining scheduled activity remained unchanged.
The group of specialists that prepared this proposal, coordinated by the doctor Diogo Ayres de Campos, also argues that, before any decision to concentrate emergencies in Obstetrics and Gynecology/Birth Block, it is necessary to “ensure the quality and safety of obstetric care and neonatal units in the surrounding units, through local visits”.
“The final decision to concentrate these resources needs to be preceded by a detailed assessment of the facilities and equipment of the surrounding hospitals, as well as their human resources”, refer the experts.