[Crispie]

<p>Hello ladies. I'm a fairly new student and would like to think of myself as fairly well versed, but this topic has me a tad bit stuck. What are the differences between protocols, standards and guidelines? We are discussing protocols mostly but the terms guidelines and standards are also often used in discussions and articles. My preceptor uses many papers for her clients all titled "informed consent regarding xyz" that explains in detail a particular presenting situation and the client signs her understanding and states her desired course of action. My understanding was that protocols and informed consent are two separate things although I cannot define protocol as clearly as I could explain and understand informed consent.</p>
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<p>I am in CA and the only things I seem to pull up are that California <span style="text-decoration:underline;">Nurse</span> midwives (I'm doing a meac accredited school for home birthing-not nurse midwifery) are required to have protocols they follow set up in coordination with their supervising physicians. I can't seem to find legal requirements about protocols for direct entry midwives or what the heck...exactly...protocol means? I was under the thinking that a protocol is meeting the requirements of the law in handling a presenting issue or situation. (ie; breech, or even standard testing etc) A guideline was like...procedure...that could be altered as long as the protocol was met. Standards of care would be what is acceptable to the profession.</p>
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<p>Specifically I need to answer the difference between protocol and guideline, the legal ramifications of each and what should be included when writing a protocol. I'm stuck because I don't have a clear understanding of what a protocol is and I can't seem to find anything related to direct entry midwifery california laws stating protocol requirements. Does informed consent = protocols? </p>
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<p>Any enlightenment would be appreciated and I would love to hear how this all works and what it means in other states as well.</p>

 

[HouseofFire]

<p>I'm also a new student midwife in CA. My school had us read a document about the differences between practice guidelines and protocols. Unfortunately I don't think i can post it here. Hopefully I have this all correct, my memory is that the basics are they are both practice-directive documents, they define your scope of practice and most people/organizations including NARM do not differentiate between the two. They both refer to what you as the midwife will do if you are presented with whatever situation you are presented with from general care to specific concerns, these are for your records and are how you plan to practice, they can also be used for or against you in a court of law.</p>
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<p>Protocols are very strict if x happens you do y then z. They are basically step by step instructions. They are usually used to protect a group because everyone agrees to the same protocols and if any one practitioner goes outside those bounds then they are on their own.</p>
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<p>Guidelines are much more open, if x happens you might consider y or z, you have a variety of possible options. They should be evidence based suggestions. The language is very open and allows you much more flexibility in the way you practice and let's you look at the whole picture with the individual woman deciding together what she wants and what you are comfortable with. They are both written in outline form.</p>
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<p>Informed choice documents I believe are as you described them, they give the client information and then can be used by the midwife to document that that the client was informed of her choices and her consent or refusal.</p>
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<p>Standards of practice I believe are the standards agreed upon, but I'm not sure by who, maybe the law? I did find this, but being a new student I'm not sure if these are actually California law or not: <a href="http://www.collegeofmidwives.org/prac_issues01/alisonguide00a.htm" target="_blank">http://www.collegeofmidwives.org/prac_issues01/alisonguide00a.htm</a></p>
<p>I think this may also include the MANA core competencies: <a href="http://mana.org/manacore.html" target="_blank">http://mana.org/manacore.html</a></p>
<p>Here's what NARM says about it: <a href="http://www.narm.org/practiceguidelines.htm" target="_blank">http://www.narm.org/practiceguidelines.htm</a></p>
<p>Hopefully this helped you!</p>
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<p>Mikalia</p>

 

[Crispie]

<p>Thank you Mikalia!</p>
<p>That does help! I had a huge discussion about this with my preceptors who looked some things up. Apparently there is discrepancies...even at the annual meetings about which words mean which. Whatever she was looking at said that guidelines are basically the federal level, then protocols was more a state/law level and then you have standards of practice for your own business that state your steps for each situation that may come up. It's all SO confusing to me still, but we are plugging along. I don't have to make my own Protocols/standards until I'm close to graduation since they will frequently change anyway. For now I'm pouring over my preceptors paperwork, which seems to not be titled anything like what we just learned LOL!</p>
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<p>I think informed consent and client signatures seems to be what's most important, no matter what it is all called.</p>
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<p>I'll be glad when this section is passed. <span><img alt="redface.gif" src="http://files.mothering.com/images/smilies/redface.gif"></span></p>