Cassidy Paul Richard
Complutense University of Madrid, Umamanita (Stillbirth and Neonatal Death Charity), Carrer Major 3, 17133, Girona, Spain.
J Perinat Med. 2022 Apr 26;50(6):832-843. doi: 10.1515/jpm-2021-0489. Print 2022 Jul 26.
To investigate which objective (actions/interventions) and subjective (perceptions of care quality) outcomes of care following stillbirth or termination of pregnancy predict perceived care quality.
A cross-sectional descriptive study using an anonymous online survey. The population was women who had experienced a stillbirth or termination of pregnancy from ≥16 weeks of gestation, in the Spanish health system. Multiple sequential regression analysis was used to identify predictors of perceived care quality (satisfaction, willingness to recommend, competence and ability to provide loss-focused care).
Results from 610 women were analysed. A significant regression equation (p<0.001) was found in each of the objective only and objective-subjective models. In the case of overall care (satisfaction-recommend composite), 72.0% of variance (adj. R2) was explained. In general, subjective evaluations of care are more potent predictors of perceived care quality than objective care interventions (e.g. autopsy performed). Feeling free to 'express emotions', 'teamwork between doctors and nurses/midwives', and 'being well-informed of all steps and procedures' were the three strongest predictors, followed by perception of 'medical negligence'. Information provision and loss-focused interventions had the weakest influence, except in the specific 'loss-focused' model.
The results indicate that the 'atmosphere' of care is a transversal dimension related to the context of loss and trauma and has the single greatest influence on perceptions of care quality. It is necessary to use a specific 'loss-focused' care variable to adequately capture perceptions of the quality of bereavement care and a custom scale to measure the influence of care interventions on perceived quality.
调查死产或终止妊娠后护理的哪些客观（行动/干预措施）和主观（护理质量感知）结果可预测感知到的护理质量。
采用匿名在线调查进行横断面描述性研究。研究对象为西班牙医疗系统中妊娠≥16周经历过死产或终止妊娠的女性。采用多重逐步回归分析来确定感知护理质量（满意度、推荐意愿、提供以丧亲之痛为重点护理的能力）的预测因素。
对610名女性的结果进行了分析。在仅包含客观因素的模型和客观 - 主观因素模型中均发现了显著的回归方程（p<0.001）。就整体护理（满意度 - 推荐综合指标）而言，72.0%的方差（调整后R²）得到了解释。总体而言，护理的主观评价比客观护理干预措施（如进行尸检）更能有效预测感知到的护理质量。能够自由“表达情感”、“医生与护士/助产士之间的团队合作”以及“充分了解所有步骤和程序”是三个最强的预测因素，其次是对“医疗过失”的感知。信息提供和以丧亲之痛为重点的干预措施影响最弱，特定的“以丧亲之痛为重点”模型除外。
结果表明护理“氛围”是与丧亲之痛和创伤背景相关的一个横向维度，对护理质量感知的影响最大。有必要使用特定的“以丧亲之痛为重点”护理变量来充分捕捉对丧亲护理质量的感知，并使用定制量表来衡量护理干预措施对感知质量的影响。
