Hi, All: I think what you might be referring to, Becky, is not formal
protocols but "scripting". Prototol, in my mind, refers to formal
written "policies and procedures" that are kept in large binders on the
unit and to which one refers to to find out how things are done, such as
how to do a blood draw, how to administer IV fluids, how to assist a mother
with breastfeeding, how to store EBM, etc. Scripting means what to "say"
as opposed to what to "do". Our hospital has been looking at scripting as
a way to standardize what everyone is saying to a mother. For example, we
sometimes have issues with patient satisfaction when the patient "expects"
to have access to lactation services 24/7. Some of the doctors' offices
are leading their patients to believe that an LC will be available to them
24/7 in the hospital. Sometimes the nursing staff leads the mother to
believe that the LC will be in right now! when realistically, she might not
be able to be seen for another half hour to one hour. I think a mother
perceives better attention and care when she is told: "The lactation
consultant is here today. She will be in sometime this morning to see
you." as opposed to: "The lactation consultant will be right in." Both of
these statements let the mother know that the lacation consultant is
available to her today, but the first statement assures her she will be
seen within a realistic time frame, rather than "right now" which is a
physical impossiblity when one LC is responsible for rounds on 15 mothers
that day.
I think most staff have good correct breastfeeding information in their
teaching arsenal, but it may be in how it is presented (said) that can make
all the difference as to how the mother is taking it in.
I do have some unease myself with "scripting" as it is so easy to forget
that a thorough ongoing assessment/history taking is essential to providing
good care and that "scripting" must not take the place of a thorough
assessment. So this is what your manager may be thinking, not questioning
anyone's clinical competencies.
Pam Hirsch, RN,BSN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL USA
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