Blackman Ian R, Shifaza Fathimath
College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
J Nurs Manag. 2022 Nov;30(8):4578-4586. doi: 10.1111/jonm.13879. Epub 2022 Nov 27.
The aim of this study is to reliably estimate why midwifery care is missed and to crystallize those factors that have causal links to it.
Studies involving the incidences and types of missed midwifery care are sparsely described. The rationales behind these deficits in care are even less well researched.
A non-experimental, descriptive method using a Likert developed MISSCARE scale was used to measure consensus estimates made by Australian midwives. Data analysis was undertaken using both Rasch analysis and Structural Equation Modeling.
Midwives' rationales behind why Australian midwifery care is missed can be quantified based on consensus estimates of participating midwives and the variances in the total scores of how important each contributing factor was in accounting for why midwifery care was missed, can be both explained and predicted.
Ten latent variables have significant predictor effects on why midwifery care was missed. These include insufficient human and physical care resources, increased work intensity and issues with workplace communication. These factors are further exacerbated by the midwives' teamwork satisfaction levels, work roster preferences and other midwife demographic variables. The age of midwife, their highest qualification achieved and where they obtained their midwifery credentials had no influence on their consensus estimates as to why midwifery care was missed.
While this study confines itself to the Australian midwifery context, outcomes are informative for an international midwifery management audience. While the setting of the midwifery practice (be it private or public hospitals) is not significant in predicting why midwifery care is missed, resource allocation for care of mothers and their babies remains instrumental, as a factor contributing to care omissions. Midwife demographic factors including age, type of midwifery qualification and where the credentials were obtained from exerted no influence as to why care was omitted. Midwifery recruitment should focus instead on re-dressing skills and skills mix shortages. Teamwork skills within the midwifery sector requires strengthening, as problems arising from workplace communication, coupled with decreased midwifery staffing numbers and increased work intensity, are strongly thought to be significant reason for missed care.
本研究旨在可靠地估计为何会错过助产护理，并明确与之存在因果关系的因素。
关于错过助产护理的发生率和类型的研究描述稀少。对这些护理缺陷背后的基本原理的研究更少。
采用一种非实验性的描述性方法，使用李克特编制的MISSCARE量表来衡量澳大利亚助产士做出的共识性估计。数据分析采用拉施分析和结构方程模型。
基于参与助产士的共识性估计，可以量化澳大利亚错过助产护理背后的助产士基本原理，并且可以解释和预测每个促成因素在解释为何错过助产护理方面的重要性总分中的差异。
十个潜在变量对为何错过助产护理具有显著的预测作用。这些因素包括人力和物力护理资源不足、工作强度增加以及工作场所沟通问题。助产士的团队合作满意度水平、工作排班偏好和其他助产士人口统计学变量进一步加剧了这些因素。助产士的年龄、最高学历以及获得助产资格证书的地点对他们关于为何错过助产护理的共识性估计没有影响。
虽然本研究仅限于澳大利亚的助产背景，但研究结果对国际助产管理受众具有参考价值。虽然助产实践的环境（无论是私立还是公立医院）在预测为何错过助产护理方面并不重要，但为母婴护理分配资源仍然至关重要，这是导致护理遗漏的一个因素。助产士人口统计学因素，包括年龄、助产资格类型以及获得资格证书的地点，对为何遗漏护理没有影响。助产士招聘应转而关注弥补技能和技能组合方面的短缺。助产行业内的团队合作技能需要加强，因为工作场所沟通产生的问题，再加上助产士人员数量减少和工作强度增加，被认为是错过护理的重要原因。
