USAID Health Care Improvement Project, University Research Co,, LLC, Wisconsin Boulevard, Bethesda, MD, USA.
Implement Sci. 2011 Jan 6;6:2. doi: 10.1186/1748-5908-6-2.
Shifting the role of counseling to less skilled workers may improve efficiency and coverage of health services, but evidence is needed on the impact of substitution on quality of care. This research explored the influence of delegating maternal and newborn counseling responsibilities to clinic-based lay nurse aides on the quality of counseling provided as part of a task shifting initiative to expand their role.
Nurse-midwives and lay nurse aides in seven public maternities were trained to use job aids to improve counseling in maternal and newborn care. Quality of counseling and maternal knowledge were assessed using direct observation of antenatal consultations and patient exit interviews. Both provider types were interviewed to examine perceptions regarding the task shift. To compare provider performance levels, non-inferiority analyses were conducted where non-inferiority was demonstrated if the lower confidence limit of the performance difference did not exceed a margin of 10 percentage points.
Mean percent of recommended messages provided by lay nurse aides was non-inferior to counseling by nurse-midwives in adjusted analyses for birth preparedness (β = -0.0, 95% CI: -9.0, 9.1), danger sign recognition (β = 4.7, 95% CI: -5.1, 14.6), and clean delivery (β = 1.4, 95% CI: -9.4, 12.3). Lay nurse aides demonstrated superior performance for communication on general prenatal care (β = 15.7, 95% CI: 7.0, 24.4), although non-inferiority was not achieved for newborn care counseling (β = -7.3, 95% CI: -23.1, 8.4). The proportion of women with correct knowledge was significantly higher among those counseled by lay nurse aides as compared to nurse-midwives in general prenatal care (β = 23.8, 95% CI: 15.7, 32.0), birth preparedness (β = 12.7, 95% CI: 5.2, 20.1), and danger sign recognition (β = 8.6, 95% CI: 3.3, 13.9). Both cadres had positive opinions regarding task shifting, although several preferred 'task sharing' over full delegation.
Lay nurse aides can provide effective antenatal counseling in maternal and newborn care in facility-based settings, provided they receive adequate training and support. Efforts are needed to improve management of human resources to ensure that effective mechanisms for regulating and financing task shifting are sustained.
将咨询的角色转移给技能水平较低的工作者可能会提高卫生服务的效率和覆盖范围，但需要有证据表明这种替代对护理质量的影响。本研究探讨了将产妇和新生儿咨询的责任委托给诊所基础的助理护士，以扩大其角色范围，这对提供咨询的质量的影响。
培训助产士和助理护士使用工作辅助工具来改善产妇和新生儿护理的咨询。通过对产前咨询的直接观察和患者出口访谈来评估咨询的质量和产妇的知识。对两种类型的提供者进行访谈，以研究他们对任务转移的看法。为了比较提供者的绩效水平，如果绩效差异的置信下限不超过 10 个百分点的差距，则进行非劣效性分析，以证明非劣效性。
在调整后的出生准备（β=-0.0，95%CI：-9.0，9.1）、危险信号识别（β=4.7，95%CI：-5.1，14.6）和清洁分娩（β=1.4，95%CI：-9.4，12.3）方面，助理护士提供的推荐信息百分比在调整分析中与助产士提供的咨询不劣于。助理护士在一般产前保健方面的沟通表现优于助产士（β=15.7，95%CI：7.0，24.4），但新生儿保健咨询的非劣效性未达到（β=-7.3，95%CI：-23.1，8.4）。与接受助产士咨询的妇女相比，接受助理护士咨询的妇女在一般产前保健（β=23.8，95%CI：15.7，32.0）、出生准备（β=12.7，95%CI：5.2，20.1）和危险信号识别（β=8.6，95%CI：3.3，13.9）方面的正确知识比例显著更高。两种工作人员对任务转移都有积极的看法，尽管有几个更喜欢“任务分担”而不是完全委托。
在医疗机构环境中，助理护士可以提供有效的产妇和新生儿保健产前咨询，前提是他们接受充分的培训和支持。需要努力改善人力资源管理，以确保有效的监管和融资任务转移机制得以维持。
