Cord-care practice in Scotland

Objective: to identify the range of policies, practices and rationale for u mbilical-cord stump care in the NHS in Scotland, Design: a postal questionnaire survey completed in two stages,The first sta ge elicited the views of Heads of Midwifery/Senior Midwives, and the second stage the views of midwives, enrolled nurses and nursery nurses, Setting: NHS units in Scotland providing intrapartum care, They were separa ted into large and small units with small units having less than or equal t o 1000 deliveries per year (n = 178), and large units > 1000 deliveries per year (n = 300), Participants: the Heads of Midwifery/Senior Midwives from the 51 units were invited to participate in the study and 49 (96.1%) replied, In stage two 5 12 maternity unit employees were sent questionnaires and 300 (76.2%) replie d. These were six enrolled nurses, 20 nursery nurses and 360 midwives and f our respondents of unspecified occupation, Measurements: the existence of cord-care policies and their rationale. Findings: about half of the units that responded had a written policy. Larg e units were four times more likely than small units to have a written poli cy. Both managers and staff reported that the most common policy/agreed pra ctice was no specific care (cord observed and only cleaned if soiled),Where a written policy existed, less than one-half of the Heads of Midwifery/Sen ior Midwives and less than one third of the staff reported that the basis f or this policy was research. Key conclusions: units with a written policy are in the minority and small units are far less likely to have such a policy. Wide variation exists in p olicy, practice and rationale, Diversity within and between units creates a nxiety and disillusionment for practitioners. It may also cause confusion f or patients who are exposed to different cord-care practices either as thes e change over time or because they use different units. Implications for Practice: the midwifery profession must examine this area of practice and determine how to address this lack of evidence. Further res earch is required to determine the most effective method of cord care and h ow best to put the findings into practice, Outstanding questions which beg further investigation are: How do cords heal and separate and what bacteria are naturally involved in this process? What constitutes an infected cord as opposed to a colonised cord? (C) 2000 Harcourt Publishers Ltd.