Student Midwife Caseloading Guidelines for Sign-off Mentors
Guidelines for sign-off mentors on caseloading Introduction In the course of their training students will see a number of models of maternity care. One particular model we want them to experience is that of caseloading because it is especially appreciated and valued by women and midwives. The term caseloading means different things to different people and is generally accepted as a system in which one midwife takes responsibility for a small defined group of women for the whole of their pregnancy. Qualified midwives might have a caseload of ideally not more that 35 women per year but we envisage that students will carry a caseload of between 3 and 5 women over the course of their programme. In University documentation the terms caseload and follow up are used interchangeably to describe the women for whom students will give continuity of carer. We appreciate that not all Trusts adopt this model completely, as it may not suit their method of delivering care, but for the purposes of the students programme the women they follow up may be referred to as their caseload. However, it does not matter whether the model of care provided in your maternity unit is caseloading or not. The concept is that students will follow the woman through, even if she sees a number of different professionals in the course of her care. 1
Aims of Student Caseloading The aims of student caseloading are to: expose students to the concept of the same midwife providing all the care for a particular woman throughout pregnancy, labour and the post natal period enable students to gain experience of providing continuity of carer by following up a small number of women assist students in gaining skills in planning, delivering and evaluating individual programmes of care ensure that with increasing experience, students learn to exercise independent decision making skills and develop their own autonomy Supervision Students will always be working under the supervision of an experienced midwife. Overall support and guidance is given by students named sign-off mentor and personal/link tutor. Sign-off mentors are not expected to follow-up women with students if that is not the way you would normally work. In the course of your work you may meet students who are delivering care to their caseloading women, and whilst this may be a student you don t work with regularly, we would ask you to support them in the usual way. 2
Students cannot ever be the first point of contact for a woman. This needs to be made clear to women when the caseloading system is discussed. You can discuss with them that their point of contact will be their midwife or delivery suite, whichever system is in place in your own particular Trust. The responsibility is on students to establish what the system is in their Trust for contacting them when one of their caseload women goes into labour. Stickers have been provided to students to place on woman s notes at the time she agreed to participate in student caseloading. Women s choice and consent It is always the woman s choice to decide whether or not she wants to participate in student caseloading. At all times, her choice is paramount and she can opt out at any time during the course of her pregnancy. Information for women Students will be given an information leaflet which they can give to any woman they would like to invite to become part of their caseload. It is important to discuss the information in the leaflet, and to be able to answer any specific questions which the woman may have. 3
Students planning for a caseload Students will be selecting a different number of women depending on which programme they are on as follows: 3 year programme 5 women throughout the whole programme. Three women to be selected during the first year and a further 2 women to be selected towards the end of the second year 18 month programme 3 women throughout the whole programme. Two women to be selected during the first half of the programme and a further woman to be selected during the second half of the programme When selecting follow up women students should try to ensure an even and appropriate spread of due dates so that their workload remains manageable. It is important that students plan their caseload around home and university commitments and therefore they need to give thought to issues such as childcare, transport, annual leave, assessment deadlines, theory weeks etc. They will need to give consideration to the following: The woman s expected date of delivery; and what will happen if her expected due date falls during the student s annual leave. 4
What will happen if one of their caseloading women goes into labour when they are due to hand in an assignment. What will happen if one of their caseloading women goes into labour in the middle of the night; students will need to think about whether or not they will be in a position to leave home/family commitments and what are their transport options. Students academic achievement is important. Students should endeavour to attend as many of a woman s antenatal and postnatal appointments as possible, however we don t expect students to miss theory sessions from University to achieve this. Depending on their stage of training, students may be able to undertake some antenatal or postnatal visits on their own outside of classroom hours. You may need to make special arrangements with the student for them to give feedback to you about the visit. It has been made clear to students that the woman s wishes take priority when making appointments. Whereas antenatal and postnatal appointments can be planned in advance the timing of labour can t always be known. For this reason it may be necessary for students to leave theory sessions to attend one of their caseloading women when they go into labour. Students should ensure that their module leader is informed as soon as possible if they are going to be absent from class. 5
You will appreciate that a certain amount of flexibility will be needed to enable students to gain caseloading experience. This may involve students moving from one clinical area to another and will need co-operation from all staff as students may be working outside their allocated area for short periods of time. This system will encourage students to work flexibly and to plan their workload, and will give them a realistic view of what life is like as a midwife. This will be particularly important when their follow-up women are in labour and may mean releasing students from other placements or activities. If students miss a significant activity, such as parenting classes because they are attending a caseloading woman, they may need to be given the opportunity to gain that experience at a later date. It is students responsibility to ensure that they have a suitable caseload, however, they will seek advice from you on selecting and following up suitable women. Students should not recruit members of their own family, or their friends to their caseload. They will also probably seek your help in planning appointments and follow up visits. Communication is paramount in making the system work, therefore close liaison will be required between students, their sign-off mentors, other midwives, other student colleagues and lecturers. 6
Process During the first few months on the programme, students will be thinking about setting up their caseload. They may need help and advice from you in achieving this. They should ideally select women at their antenatal booking interview. You and your student can decide which women attending for booking are suitable to have the caseloading system discussed. At this point, the information sheet can be given to and discussed with the woman. Verbal consent should be obtained to ensure that the woman understands the student caseloading process. We would like students to select women suitable for midwifery led care at booking. However, you should use your professional judgement in deciding which women are suitable, and who may benefit from the student s continued input. Students must not recruit members of their own family, or their friends, to their caseload. Even if the woman requires input from other health care professionals, she may be low risk at booking and might remain low risk throughout her pregnancy. However, even if the type of care changes throughout the course of pregnancy, students should follow up their caseloading women regardless of any change in care. This will help students to understand the importance and value of midwifery input no matter who is the lead professional. If you have any queries as to the suitability of a particular woman for caseloading please don t hesitate to contact a member of the academic team. 7
Record keeping and documentation All students will be learning about record keeping under your guidance. Students carrying a caseload will also be keeping a record of their follow-up women in their Clinical Experience Record Book. Guidance is given in the Clinical Experience Record Book as to the details students need to record. You will be asked to sign the book to verify that students have made the visits, however you do not have to have been present at the appointment in order to sign. Communication Communication is central to the success of the caseloading experience. It relies on excellent communication between follow up women, students, midwives, managers, obstetric team, University lecturers etc. It is the student s responsibility to keep everyone informed appropriately. This is especially important as they gain more experience and may be undertaking visits on their own with indirect supervision from midwives. However, students must always visit on the direction of the midwife, and must not visit without the knowledge or permission of a midwife. Reflection and debriefing As part of their practice modules students will be attending reflective days. These will include structured sessions with student colleagues led by a module 8
leader. These will provide opportunities for students to explore issues that evolve during their caseloading practice. Please encourage students to use a reflective journal to record and analyse their experiences. 9
You may also wish to avail yourself of opportunities to reflect and debrief on your experiences of supporting students. Such opportunities are provided through mentor/assessor workshops, supervision workshops, link lecturer drop in sessions, surgeries and study days. If you wish to discuss any aspect of student midwife caseloading, or anything pertaining to student midwives, please contact any of the midwifery lecturers. As you will be aware a woman s and/or student s circumstances can change in the course of pregnancy, for example, the woman could move out of the area, the student could move to a different team or the relationship could start to challenge professional boundaries. You need to be aware of such possibilities and guide the student to provide caseloading in a professional manner at all times. Information for students Please see separate information booklet Information for women and their families Please see separate information booklet Version 8 September 2013 9
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