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;73:26-34. doi: 10.1016/j.midw.2019.03.002. Epub 2019 Mar 5.
There is evidence that continuity of care - increasingly a focus of maternity care policy in the UK - contributes to improved outcomes. However, uncertainty remains about which models of care are most effective in which circumstances, and why this is. A plausible explanation is grounded in the idea that the continuity elements of care contribute to and reinforce best quality care. The Quality Maternal and Newborn Care Framework describes the components and characteristics of quality care. As a first step in developing a maternity care evaluation toolkit, we adapted this Framework to see if it could be used to evaluate perceptions and experiences of different models of care.
A qualitative comparative enquiry using focus groups. From a six-phase thematic analysis, we first derived then compared the principal sub-themes from the focus groups and mapped these to the original Framework.
Two health boards in Scotland.
Pregnant women, new mothers, midwives and obstetricians who had experience of various models of maternity care. This paper reports findings from the pregnant women and new mothers.
These are presented in two parts: the seven focus groups with pregnant women and new mothers are reported in this paper; the five focus groups with midwives and obstetricians in our accompanying paper. Those using the maternity services had experience of caseloading midwifery, 'modified universal provision' and 'high risk' models of maternity care. While women from all groups shared certain perspectives, those with experience of caseloading midwifery were consistently positive, reporting positive relationships, tailored care and effective communication. Women experiencing other models of care, especially the modified universal provision model, tended to report more negative relational experiences: lack of information, lack of tailored care, and anxiety and confusion. Timing of the focus group (i.e. during pregnancy or after the birth) appeared to make little difference to responses. Mapping responses to the Framework's characteristics of care was straightforward; mapping also showed how the Framework's components of care are interlinked.
Our adaptation of the Quality Maternal and Newborn Care Framework as a data collection tool allowed us to compare women with experience of different models of care, and relational factors were identifiable in many responses. Positive responses were found in all models but were most emphasised in the caseloading midwifery model, suggesting that the experience of caseloading continuity and its relational elements is highly valued. While further work is required to identify if this can be linked to improved clinical outcomes, we have established that the Quality Maternal and Newborn Care Framework can be adapted as an exploratory tool for assessing perceptions and experiences of maternity care.
有证据表明，连续护理——在英国日益成为孕产妇护理政策的重点——有助于改善分娩结局。然而，对于哪种护理模式在何种情况下最有效以及原因仍存在不确定性。一个合理的解释基于这样一种观点，即护理的连续性要素有助于并强化优质护理。《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。作为开发孕产妇护理评估工具包的第一步，我们对该框架进行了调整，以检验其是否可用于评估对不同护理模式的看法和体验。
采用焦点小组进行定性比较研究。通过六个阶段的主题分析，我们首先从焦点小组中提炼出主要子主题，然后进行比较，并将这些子主题与原始框架进行映射。
苏格兰的两个卫生委员会。
有各种孕产妇护理模式经验的孕妇、新妈妈、助产士和产科医生。本文报告了孕妇和新妈妈的研究结果。
结果分为两部分呈现：本文报告了与孕妇和新妈妈进行的七个焦点小组的情况；我们的配套论文报告了与助产士和产科医生进行的五个焦点小组的情况。使用孕产妇服务的人有个案管理助产、“改良通用服务”和“高风险”孕产妇护理模式的经验。虽然所有组的女性都有一些共同的观点，但有个案管理助产经验的女性一直持积极态度，她们报告了良好的关系、个性化护理和有效的沟通。经历其他护理模式（尤其是改良通用服务模式）的女性往往报告更多负面的关系体验：信息不足、缺乏个性化护理以及焦虑和困惑。焦点小组的时间（即孕期或产后）似乎对回答影响不大。将回答映射到框架的护理特征上很直接；映射还显示了框架护理组成部分之间的相互联系。
我们将《优质孕产妇和新生儿护理框架》改编为数据收集工具，使我们能够比较有不同护理模式经验的女性，并且在许多回答中可以识别出关系因素。在所有模式中都发现了积极的回答，但在个案管理助产模式中最为突出，这表明个案管理连续性及其关系要素的体验受到高度重视。虽然需要进一步研究以确定这是否能与改善临床结局相关联，但我们已经确定《优质孕产妇和新生儿护理框架》可改编为评估孕产妇护理看法和体验的探索性工具。
