Symon Andrew, McFadden Alison, White Marianne, Fraser Katrina, Cummins Allison
Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, DD1 4HJ United Kingdom.
Mother and Infant Research Unit, School of Nursing and Health Sciences, University of Dundee, DD1 4HJ United Kingdom.
Midwifery. 2019 Jun;73:17-25. doi: 10.1016/j.midw.2019.03.001. Epub 2019 Mar 5.
The Quality Maternal and Newborn Care Framework describes the components and characteristics of quality care and emphasises relational and continuity elements. Continuity of care is increasingly a focus of maternity care policy in the United Kingdom. While some outcomes have been shown to be improved, there is uncertainty about why certain models of care are more effective. Our overall objective is to develop a maternity care evaluation toolkit which incorporates this Framework along with other outcome evaluations. An initial step in developing this toolkit was to use the adapted Framework to evaluate perceptions and experiences of maternity care. Our specific objective in this study was to test this adapted Framework in a series of focus groups with key stakeholders, and to compare findings between different groups. Findings related to service users (pregnant women and new mothers) are reported in our accompanying paper; this paper presents findings from focus groups with service providers (midwives and obstetricians), and then compares user and provider perspectives.
A qualitative comparative enquiry involving three focus groups with 26 midwives (eight newly qualified; eight working in a community midwifery unit; and ten senior tertiary-based) and two focus groups with twelve obstetricians of all grades. We used a six-phase thematic analysis to derive then compare the focus groups' principal sub-themes; we then mapped these to the original Quality Maternal and Newborn Care Framework and compared these service providers' responses with those from the pregnant women and new mothers.
Two health boards in Scotland.
Midwives and obstetricians who had experience of various models of maternity care.
There were significant areas of overlap in their perceptions of providing maternity care. All groups reported 'limited resources and time'; the community midwifery unit and senior midwives and one group of obstetricians provided a critique of the system. Achieving tailored care was acknowledged as a problem by the senior midwives and one group of obstetricians. Only obstetricians discussed strategies for improvement. The newly qualified midwives were most positive in their responses. There was both overlap and contrast when comparing the views of service users and providers. We found most agreement when participants discussed some of the Framework's characteristics of care in negative terms, such as (in) accessible care, (lack of) adequate resources, and (absence of) tailored care.
Being able firstly to map the participants' responses to the Quality Maternal and Newborn Care Framework, and then to identify strengths and gaps in the provision of quality maternity care, suggests to us that the Framework, derived as it is from a comprehensive analysis of the global evidence on quality care, can indeed be used to inform an evaluation toolkit. While aware that we cannot generalise from this limited qualitative study, we are currently undertaking similar work in other countries by which we hope to confirm our findings and further develop the toolkit.
《优质孕产妇和新生儿护理框架》描述了优质护理的组成部分和特征，并强调了关系性和连续性要素。护理连续性日益成为英国孕产妇护理政策的重点。虽然已证明某些结果有所改善，但对于为何某些护理模式更有效仍存在不确定性。我们的总体目标是开发一个孕产妇护理评估工具包，将该框架与其他结果评估相结合。开发此工具包的第一步是使用经过调整的框架来评估对孕产妇护理的看法和体验。本研究的具体目标是在一系列与关键利益相关者的焦点小组中测试这个经过调整的框架，并比较不同小组的结果。我们在随附论文中报告了与服务使用者（孕妇和新妈妈）相关的结果；本文呈现了与服务提供者（助产士和产科医生）焦点小组的结果，然后比较了使用者和提供者的观点。
一项定性比较调查，包括与26名助产士（8名新获得资格者；8名在社区助产单位工作；10名高级三级医疗机构的助产士）进行的三个焦点小组，以及与各级别的12名产科医生进行的两个焦点小组。我们采用六阶段主题分析法得出并比较焦点小组的主要子主题；然后将这些子主题映射到原始的《优质孕产妇和新生儿护理框架》，并将这些服务提供者的回答与孕妇和新妈妈的回答进行比较。
苏格兰的两个卫生委员会。
有各种孕产妇护理模式经验的助产士和产科医生。
他们在对提供孕产妇护理的看法上有显著的重叠领域。所有小组都报告了“资源和时间有限”；社区助产单位、高级助产士以及一组产科医生对该系统提出了批评。高级助产士和一组产科医生承认实现个性化护理是一个问题。只有产科医生讨论了改进策略。新获得资格的助产士的回答最为积极。比较服务使用者和提供者的观点时，既有重叠也有差异。当参与者从负面角度讨论该框架的一些护理特征时，例如（难以）获得护理、（缺乏）足够资源以及（没有）个性化护理，我们发现了最多的共识。
首先能够将参与者的回答映射到《优质孕产妇和新生儿护理框架》，然后识别优质孕产妇护理提供中的优势和差距，这向我们表明，该框架源自对全球优质护理证据的全面分析，确实可用于为评估工具包提供信息。虽然我们意识到不能从这项有限的定性研究进行推广，但我们目前正在其他国家开展类似工作，希望借此确认我们的发现并进一步开发该工具包。
