Wong Shee Anna, Nagle Cate, Corboy Denise, Versace Vincent L, Robertson Carolyn, Frawley Natasha, McKenzie AnneMarie, Lodge Julie
Ballarat Health Services, Ballarat, Australia; Deakin Rural Health, Deakin University, School of Medicine, Geelong, Victoria, Australia.
James Cook University, Centre for Nursing and Midwifery Research, 1 James Cook Drive, Townsville, Queensland 4814, Australia; Townsville Hospital and Health Service, 100 Angus Smith Drive, Douglas, Queensland 4814, Australia.
Midwifery. 2019 Mar;70:46-53. doi: 10.1016/j.midw.2018.12.005. Epub 2018 Dec 13.
Prior to implementation of a Normal Labour and Birth Bundle (NLBB) at a regional maternity service in Victoria, Australia, this study aimed to understand clinician factors that may influence the uptake, acceptance and use of the NLBB.
This was a mixed methods study in which The Theory of Planned Behaviour (TPB) provided the framework for the conduct and analysis of the staff survey and focus groups. Descriptive and multiple regression were used to analyse the survey data and thematic analysis was used for the focus group data.
Participants for the survey and focus groups included clinicians providing publicly funded care and management of labour for women birthing at the health service. Maternity care clinicians were invited to participate in both the survey and the focus groups.
Seventy-six clinicians (88.8%) responded to the survey. Mean scores for TPB constructs were well above the mid-scale score of 4, indicating strong positive attitudes, high levels of self-efficacy and positive social pressure to use the NLBB and strong intentions to use it in the future. Self-efficacy was the strongest independent predictor (β = 0.45, p < 0.001) of intention to use the NLBB (overall model R2=0.38). A valued consequence of implementing standardised and objective guidelines, highlighted in the focus groups, was the positive impact on clinicians' confidence in their decision-making.
This study found that midwives and obstetricians were in favour of using a normal labour and birth care bundle and perceived the bundle to align with the expectations of work colleagues and the women they care for. The findings of this study show that clinicians at the health service had strong intentions to use the normal labour and birth care bundle in the future.
Implementation science is important in embedding and sustaining practice change. Understanding staff perceptions is an essential first step of this process.
在澳大利亚维多利亚州的一个地区性产科服务机构实施正常分娩和接生综合方案（NLBB）之前，本研究旨在了解可能影响NLBB采用、接受和使用的临床医生因素。
这是一项混合方法研究，其中计划行为理论（TPB）为员工调查和焦点小组的开展及分析提供了框架。描述性分析和多元回归用于分析调查数据，主题分析用于分析焦点小组数据。
调查和焦点小组的参与者包括为在该医疗服务机构分娩的妇女提供公共资助的分娩护理和管理的临床医生。邀请产科护理临床医生同时参与调查和焦点小组。
76名临床医生（88.8%）回复了调查。TPB各构念的平均得分远高于量表中间分数4，表明对使用NLBB有强烈的积极态度、高水平的自我效能感和积极的社会压力，且未来使用NLBB的意愿强烈。自我效能感是使用NLBB意愿的最强独立预测因素（β = 0.45，p < 0.001）（总体模型R2 = 0.38）。焦点小组强调，实施标准化和客观指南的一个重要结果是对临床医生决策信心有积极影响。
本研究发现，助产士和产科医生赞成使用正常分娩和接生护理综合方案，并认为该方案符合同事及他们所护理女性的期望。本研究结果表明，该医疗服务机构的临床医生未来使用正常分娩和接生护理综合方案的意愿强烈。
实施科学对于嵌入和维持实践变革很重要。了解员工的看法是这一过程至关重要的第一步。
