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20040119-14* Midwifery care: development of
an instrument to measure quality based on the World Health Organization's
classification of care in normal birth - Journal
of Clinical Nursing , vol 13, no 1, January 2004, pp
75-83 Sandin Bojo AK; Hall-Lord ML; Axelsson O; et
al - (2004) |
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AIMS AND OBJECTIVES: The aim of the study was to
develop an instrument to measure midwifery care in relation to World
Health Organization's classification of care in normal birth and to test
the instrument for content validity and inter-rater reliability. METHODS:
The Delphi method was used for development of the instrument and to elicit
evidence of content validity. Six experts from three different
geographical regions in Sweden, representing clinically working midwives,
lecturers in midwifery and obstetricians, participated in the first part
of the study. The instrument was tested for inter-rater reliability in an
exploratory study by two midwives and one of the authors. Data were
analysed using percentage of agreement level and the Kappa coefficient.
RESULTS: Five expert rounds were needed to reach consensus for content
validity. The inter-rater reliability test showed high agreement levels
(95.9, 94.2 and 95.7%) and good to very good Kappa coefficients
(0.74-1.0). The final instrument consisted of 78 items divided into five
sections: background (five items); practices which are demonstrably useful
and should be encouraged (55 items); practices which are clearly harmful
or ineffective and should be eliminated (five items); practices for which
insufficient evidence exists to support a clear recommendation and which
should be used with caution while further research clarifies the issue
(four items); and finally practices which are frequently used
inappropriately (nine items). CONCLUSIONS AND RELEVANCE TO CLINICAL
PRACTICE: The instrument can be used at a labour ward to measure
documented care and quality of midwifery care. The results can be used to
identify areas for improvements, to develop guidelines towards
evidence-based care and to improve documentation. However, the present
study should be regarded as an exploratory study and the feasibility of
the instrument remains to be tested in empirical studies.
(Author) |
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