Western Norway University of Applied Science, Inndalsveien 285063 Bergen, Norway.
Western Norway University of Applied Science, Inndalsveien 285063 Bergen, Norway.
Midwifery. 2023 Jul;122:103676. doi: 10.1016/j.midw.2023.103676. Epub 2023 Apr 6.
The aim of this study was to explore midwives' experiences with a safe childbirth checklist used in handover situations from birth to hospital discharge. Quality of care and patient safety is highly recognised and a priority within health services globally. In handover situations, checklists have proven to reduce unwanted variation by standardising processes, which in turn contribute to increased quality of care. To improve the quality of care, a safe childbirth checklist was implemented at a large maternity hospital in Norway.
We conducted a Glaserian grounded theory (GT) study.
A total of 16 midwives were included. We included three midwives in one focus group and conducted 13 individual interviews. Years of experience as midwives ranged from one to 30 years. All included midwives worked in a large maternity hospital in Norway.
The main concern faced by the midwives who used the checklist included no common understanding of the purpose of the checklist nor consensus on how to use the checklist. The generated grounded theory, individualistic interpretation of the checklist, involved the following three strategies that all seemed to explain how the midwives solved their main concern: 1) not questioning the checklist, 2) constantly evaluating the checklist, and 3) distancing oneself from the checklist. Experiencing an unfortunate event concerning the healthcare of both mother or newborn was a condition that could alter the midwives understanding and use of the checklist.
The findings in this study showed that a general lack of common understanding and consensus on the rationale for implementing a safe childbirth checklist led to variations between midwives in how and whether the checklist was used. The safe childbirth checklist was described as long and detailed. It was not necessarily the midwife who was expected to sign the checklist who had carried out the tasks signed for. To ensure patient safety, recommendations for future practice include securing that separate sections of a safe childbirth checklist are limited to a specific time-point and midwife.
Findings emphasise the importance of implementation strategies supervised by the leaders of the healthcare services. Further research should explore the understanding of organisational and cultural context when implementing a safe childbirth checklist to clinical practice.
本研究旨在探讨助产士在从分娩到出院交接过程中使用安全分娩检查表的经验。在全球卫生服务中，护理质量和患者安全受到高度重视和优先考虑。在交接情况下，检查表已被证明通过标准化流程减少了不必要的差异，从而有助于提高护理质量。为了提高护理质量，挪威的一家大型妇产医院实施了安全分娩检查表。
我们进行了扎根理论（GT）研究。
共纳入 16 名助产士。我们在一个焦点小组中纳入了 3 名助产士，并进行了 13 次单独访谈。助产士的工作年限从 1 年到 30 年不等。所有参与的助产士都在挪威的一家大型妇产医院工作。
使用检查表的助产士面临的主要问题是对检查表目的缺乏共同理解，也没有就如何使用检查表达成共识。生成的扎根理论，即对检查表的个体解释，涉及以下三个策略，这些策略似乎都解释了助产士如何解决她们的主要问题：1）不质疑检查表，2）不断评估检查表，3）与检查表保持距离。遇到与母婴健康有关的不幸事件是一种可能改变助产士对检查表的理解和使用的情况。
本研究的结果表明，对实施安全分娩检查表的基本原理缺乏共同的理解和共识，导致助产士在如何以及是否使用检查表方面存在差异。安全分娩检查表被描述为冗长而详细。预期签署检查表的不一定是执行签名任务的助产士。为了确保患者安全，对未来实践的建议包括确保安全分娩检查表的单独部分仅限于特定的时间点和助产士。
研究结果强调了实施策略由医疗服务领导者监督的重要性。进一步的研究应探讨在将安全分娩检查表实施到临床实践中时对组织和文化背景的理解。
