Grady Julie, Blair Anna, Brimdyr Kajsa, Cadwell Karin
School of Nursing and Health Sciences, Curry College, Milton, MA 02186, USA.
Healthy Children Project, Inc., Harwich, MA 02645, USA.
Nurs Rep. 2024 Dec 20;14(4):4119-4128. doi: 10.3390/nursrep14040300.
Despite the short- and long-term acknowledged benefits of breastfeeding for mothers and their infants, worldwide rates trail behind international goals. Prior research confirms that breastfeeding is a nurse sensitive indicator and that problems with latching the baby and painful breastfeeding rank high among the reasons given for not continuing to breastfeed. The Lactation Assessment Tool (LAT) was previously evaluated in a study conducted in Latvia by nurse midwives. Use of the LAT to assess breastfeeding and suggesting corrective interventions were shown to decrease pain and promote healing in traumatized nipples. The inter-rater reliability for that study was by test/re-test amongst participating researcher midwives. The aim of the current study is to expand the understanding of LAT inter-rater reliability to include novice and expert assessors.
A convenience sample of twenty participants, including both novices (nine nursing students) and 11 self-identified experts, assessed four videos of breastfeeding dyads using the assessment tool, the LAT. Novice participants received a 2 h training session before final tool assessment. Each video was viewed three times, with a 3 min pause between viewings. All elements of the LAT that could be visually evaluated were included, with each element appearing in at least two of the videos.
Acceptable internal consistency of the LAT tool was found, with Cronbach's alpha measuring 0.799, 0.740, 0.756 and 0.735 for each video, respectively. The reliability of the novice assessors improved over the course of the four videos, from 0.484 and 0.610 to 0.714 and 0.711. All of the experts had Cronbach's alpha numbers that were acceptable, ranging from 0.769 to 1.00.
Results indicate that experts perform much better using the tool than trained novices. However, the subsequent use of the tool resulted in the last two video assessments having an acceptable measure for the trained novice group. The LAT is a reliable tool for trained novices and experts to assess breastfeeding positioning and latch.
尽管母乳喂养对母亲及其婴儿的短期和长期益处已得到公认，但全球母乳喂养率仍落后于国际目标。先前的研究证实，母乳喂养是一项护理敏感指标，婴儿衔接问题和母乳喂养疼痛是停止母乳喂养的主要原因。泌乳评估工具（LAT）先前在拉脱维亚由助产护士进行的一项研究中得到评估。使用LAT评估母乳喂养并提出纠正干预措施可减轻疼痛并促进受损乳头的愈合。该研究的评分者间信度是通过参与研究的助产士之间的重测得到的。本研究的目的是扩大对LAT评分者间信度的理解，将新手和专家评估者纳入其中。
选取了20名参与者作为便利样本，包括新手（9名护理专业学生）和11名自称的专家，他们使用泌乳评估工具（LAT）对四段母乳喂养二元组的视频进行评估。新手参与者在最终工具评估前接受了2小时的培训课程。每个视频观看三次，每次观看之间暂停3分钟。纳入了LAT所有可通过视觉评估的要素，每个要素至少在两个视频中出现。
发现LAT工具具有可接受的内部一致性，每个视频的Cronbach's α系数分别为0.799、0.740、0.756和0.735。新手评估者的信度在四段视频过程中有所提高，从0.484和0.610提高到0.714和0.711。所有专家的Cronbach's α系数均在可接受范围内，从0.769到1.00。
结果表明，专家使用该工具的表现比经过培训的新手好得多。然而，该工具的后续使用使得最后两段视频评估对于经过培训的新手组来说具有可接受的测量结果。LAT是经过培训的新手和专家评估母乳喂养姿势和衔接情况的可靠工具。
