Assessing staff-oriented care with developmental support approach in Iranian NICUs.

BACKGROUND: Regarding improvements in preterm infants' survival rates, it is necessary the improvement of Neonatal Intensive Care Unit (NICUs) status in order to provide comprehensive care. The aim of this study was to assess the aspects of staffing-oriented neonatal care in NICUs affiliated to Universities of Medical Sciences in Iran. METHODS: This survey is a cross-sectional study which was conducted in 23 NICUs of nine type-1 Universities of Medical Sciences across country. The study checklist contained 39 items in four domains, including "Composition, Philosophy, Training, and Support", "Management", "Resources", and "Transition Systems". Data were gathered through observation and analyzed using Stata software, version 13. RESULTS: In this study, the mean score of staffing-oriented care was 43.5 of 100. In none of the studied domains, the mean score obtained was not above 50. Among the four domains studied, the highest score was related to "Management", (the mean score of 50 of 100) and the lowest score related to "Resources" (the mean score of 35 of 100). CONCLUSIONS: Considering the importance of the role of health professionals in the neonatal comprehensive care, and also the low mean score of staffing-oriented care (43.51 out of 100) and also its items in NICUs in this study, it is concluded that more attention is needed for staff-oriented care as well as the strengthening of this dimension of developmental care along with other dimensions, through designing of appropriate interventions to improve the health outcomes of preterm infants.

The Mother-Newborn Skin-to-Skin Contact Questionnaire (MSSCQ): development and psychometric evaluation among Iranian midwives.

BACKGROUND: Despite the benefits of mother-newborn skin-to-skin contact immediately after birth, it has not been universally implemented as routine care for healthy term neonates. Midwifes are the first person to contact the neonate after birth. However, there is evidence that many midwives do not perform mother-newborn skin-to-skin contact. The aim of this study was to develop and psychometrically evaluate an instrument for measuring factors associated with mother-newborn skin-to-skin contact (MSSCQ) based on the PRECEDE-PROCEED model. METHODS: This was a two-phase qualitative and quantitative study. It was conducted during 2010 to 2012 in Tehran, Iran. In the qualitative part, 150 midwives working in labor room participated in 19 focus group discussions in order to generate a preliminary item pool. Then, content and face validity were performed to provide a pre-final version of the questionnaire. In the quantitative phase, reliability (internal consistency and test-retest analysis), validity and factor analysis (both exploratory and confirmatory) were performed to assess psychometric properties of the instrument. RESULTS: A 120-item questionnaire was developed through the qualitative phase. It was reduced to an 83-item after content validity. The exploratory factor analysis loaded fifteen-factors and three constructs (predisposing, enabling and reinforcing) containing 82 items (38, 18, and 26 statements, respectively) that jointly accounted for 60.61% of observed variance. The Confirmatory factors analysis determined a model with appropriate fitness for the data. The Cronbach's alpha coefficient showed excellent internal consistency (alpha = 0.92), and test-retest of the scale with 2-week intervals indicated an appropriate stability for the MSSCQ (ICC = 0.94). CONCLUSION: The Mother-Newborn Skin-to-Skin Contact Questionnaire (MSSCQ) is a reliable and valid theory-based measurement and now can be used in clinical practice, midwifery and nursing studies.