Midwives' insights in relation to the common barriers in providing effective perinatal care to women from ethnic minority groups with 'high risk' pregnancies: A qualitative study.

PROBLEM: Childbearing women from ethnic minority groups in the United Kingdom (UK) have significantly poorer perinatal outcomes overall. BACKGROUND: Childbearing women from ethnic minority groups report having poorer experiences and outcomes in perinatal care, and health professionals report having difficulty in providing effective care to them. Yet barriers in relation to providing such care remain underreported. AIM: The aim of this study was to elicit midwives' insights in relation to the common barriers in providing effective perinatal care to women from ethnic minority groups with 'high risk' pregnancies and how to overcome these barriers. METHODS: A qualitative study was undertaken in a single obstetric led unit in London, UK. A thematic analysis was undertaken to identify themes from the data. FINDINGS: A total of 20 midwives participated. They self-identified as White British (n=7), Black African (n=7), Black Caribbean (n=3) and Asian (n=3). Most (n=12) had more than 10 years' experience practising as a registered midwife (range 2 - 35 years). Four themes were identified: 1) Communication, 2) Continuity of carer, 3) Policy and 4) Social determinants. Racism and unconscious bias underpin many of the findings presented. DISCUSSION: Co-created community hubs may improve access to more effective care for childbearing women from ethnic minority groups. A focus on robust anti-racism interventions, continuity of carer, staff wellbeing and education along with the provision of orientation and bespoke translation services are also suggested for the reduction of poorer outcomes and experiences. CONCLUSION: Along with policies designed to promote equality and irradicate racism, there is a need for co-created community hubs and continuity of carer in perinatal services. Further research is also required to develop and evaluate culturally safe, and evidence-based interventions designed to address the current disparities apparent.

Design and validation of a three-instrument toolkit for the assessment of competence in electrocardiogram rhythm recognition.

BACKGROUND: Rapid and accurate interpretation of cardiac arrhythmias by nurses has been linked with safe practice and positive patient outcomes. Although training in electrocardiogram rhythm recognition is part of most undergraduate nursing programmes, research continues to suggest that nurses and nursing students lack competence in recognising cardiac rhythms. In order to promote patient safety, nursing educators must develop valid and reliable assessment tools that allow the rigorous assessment of this competence before nursing students are allowed to practise without supervision. AIM: The aim of this study was to develop and psychometrically evaluate a toolkit to holistically assess competence in electrocardiogram rhythm recognition. METHODS: Following a convenience sampling technique, 293 nursing students from a nursing faculty in a Spanish university were recruited for the study. The following three instruments were developed and psychometrically tested: an electrocardiogram knowledge assessment tool (ECG-KAT), an electrocardiogram skills assessment tool (ECG-SAT) and an electrocardiogram self-efficacy assessment tool (ECG-SES). Reliability and validity (content, criterion and construct) of these tools were meticulously examined. RESULTS: A high Cronbach's alpha coefficient demonstrated the excellent reliability of the instruments (ECG-KAT=0.89; ECG-SAT=0.93; ECG-SES=0.98). An excellent context validity index (scales' average content validity index>0.94) and very good criterion validity were evidenced for all the tools. Regarding construct validity, principal component analysis revealed that all items comprising the instruments contributed to measure knowledge, skills or self-efficacy in electrocardiogram rhythm recognition. Moreover, known-groups analysis showed the tools' ability to detect expected differences in competence between groups with different training experiences. CONCLUSION: The three-instrument toolkit developed showed excellent psychometric properties for measuring competence in electrocardiogram rhythm recognition.

Development and psychometric evaluation of the arterial puncture self-efficacy scale.

BACKGROUND: Arterial puncture for arterial blood gases (ABG) analysis can be a risky, painful, difficult-to-perform procedure that is often insufficiently practised and generates stress and discomfort amongst patients and healthcare professionals. Self-efficacy is a key component in the acquisition of procedural skills. Therefore, professionals' self-efficacy in arterial puncture should be measured before attempting the procedure on real patients. OBJECTIVE: To develop and psychometrically assess a self-efficacy scale in arterial puncture. DESIGN: An observational cross-sectional design was used in this study. SETTING: Faculty of Education Sciences, Nursing and Physiotherapy in a higher education institution in the south of Spain. PARTICIPANTS: A convenience sample of 342 nursing students entered and completed the study. All participants met the following inclusion criteria: (1) ≥18years old and (2) enrolled in a nursing degree programme during the 2014/2015 academic year. Participants were 74% female (n=254) and their age ranged from 18 to 50, with a mean age of 21.74years (SD=5.14). METHOD: The Arterial Puncture Self-Efficacy Scale (APSES) was developed and psychometrically tested. Reliability and content validity were studied. Predictive validity and concurrent validity assessed criterion validity. In addition, principal component analysis and known-group analysis evaluated construct validity. RESULTS: Principal component analysis revealed the two-subscale structure of the final 22-item version of the Arterial Puncture Self-Efficacy Scale (APSES). A total Cronbach's alpha coefficient of 0.97 showed its high reliability. The APSES' content validity index was excellent (S-CVI/Ave=0.95). Predictive and concurrent validity analysis demonstrated the good criterion validity of the tool. Supporting the APSES' sensitivity and specificity, known-groups analysis evidenced significant differences (p<0.001) in self-efficacy levels between groups. CONCLUSION: The APSES showed good psychometric properties for measuring self-efficacy in arterial puncture for ABG analysis.

Development and psychometric assessment of the Basic Resuscitation Skills Self-Efficacy Scale.

BACKGROUND: Nurses are usually the first responders to an in-hospital cardiac arrest. As bystanders, nurses are expected to master some basic resuscitation skills. Self-efficacy levels are a key component in the acquisition of basic resuscitation skills. AIM: To develop, test and validate a self-efficacy scale that accurately measures nursing students' confidence levels in their capabilities when responding to a cardiac arrest. METHODS: This study enrolled a conveniently recruited sample of 768 nursing students from two different universities in Europe. The Basic Resuscitation Skills Self-Efficacy Scale (BRS-SES) was developed and its psychometrics established. Content validity, criterion validity, discriminant validity, and internal consistency were assessed. Performing item-analysis, principal component analysis and known group analysis evaluated construct validity. RESULTS: Principal component analysis revealed the three-subscale structure of the final 18-item BRS-SES. A Cronbach's alpha of 0.96 for the overall measure demonstrated the internal consistency of the BRS-SES. Data also evidenced discriminant ability of the BRS-SES and known-group analysis showed its high sensitivity and specificity. CONCLUSION: The BRS-SES showed good psychometric properties for measuring self-efficacy in basic resuscitation skills that nursing students, as future first responders to an in-hospital cardiac arrest, will be expected to master.

Effects of two retraining strategies on nursing students' acquisition and retention of BLS/AED skills: A cluster randomised trial.

AIM: To determine and compare the effects of two different retraining strategies on nursing students' acquisition and retention of BLS/AED skills. METHODS: Nursing students (N = 177) from two European universities were randomly assigned to either an instructor-directed (IDG) or a student-directed (SDG) 4-h retraining session in BLS/AED. A multiple-choice questionnaire, the Cardiff Test, Laerdal SkillReporter(®) software and a self-efficacy scale were used to assess students' overall competency (knowledge, psychomotor skills and self-efficacy) in BLS/AED at pre-test, post-test and 3-month retention-test. GEE, chi-squared and McNemar tests were performed to examine statistical differences amongst groups across time. RESULTS: There was a significant increase in the proportion of students who achieved competency for all variables measuring knowledge, psychomotor skills and self-efficacy between pre-test and post-test in both groups (all p-values<0.05). However, at post-test, significantly more students in the SDG achieved overall BLS/AED competency when compared to IDG. In terms of retention at 3 months, success rates of students within the IDG deteriorated significantly for all variables except ≥ 70% of chest compressions with correct hand position (p-value = 0.12). Conversely, the proportion of students who achieved competency within the SDG only decreased significantly in 'mean no flow-time ≤ 5s' (p-value = 0.02). Furthermore, differences between groups' success rates at retention-test also proved to be significantly different for all variables measured (all p-values < 0.05). CONCLUSION: This study demonstrated that using a student-directed strategy to retrain BLS/AED skills has resulted in a higher proportion of nursing students achieving and retaining competency in BLS/AED at three months when compared to an instructor-directed strategy.