Developing a quality care-metric: unpacking public health nurses' practice during the first postnatal visit

Background Measurement of care using metrics plays an integral role in quality improvement. Quality care-metrics (QCMs) measure the quality of nursing and midwifery practice and are aligned with evidence-based standards.... [ view full abstract ]

Background
Measurement of care using metrics plays an integral role in quality improvement. Quality care-metrics (QCMs) measure the quality of nursing and midwifery practice and are aligned with evidence-based standards. Developing QCMs is a means of measuring public health nursing (PHN) practice and is important in improving outcomes of care. Within PHNs’ child and maternal health role, the first postnatal visit is acknowledged as the most important contact PHNs have with new mothers and babies. PHNs provide physical, social and emotional care for new mothers. Little is known about the processes involved and quality of this care. Exploring views of PHNs, new mothers and health professionals involved in developing and implementing QCMs, has guided the development of a QCM to identify and measure PHNs’ practice during the first postnatal visit.
Aim and Objectives
To develop a QCM to measure specific indicators of PHNs’ practice during the first postnatal visit.
Methods
Following ethical approval for this multiphase mixed methods study, four focus groups were held nationally with PHNs, key professionals involved in the development and implementation of QCMs and semi-structured individual interviews were completed with new mothers. Data were transcribed verbatim and analysed using thematic network analysis. This data combined with relevant literature identified 58 individual indicators to explain the processes of PHN practice. A two round ‘modified Delphi’ process with a panel of 23 experts incorporating these potential indicators was commenced to combine evidence based practice with expert consensus.
Findings
The 58 indicators included in a ‘modified Delphi’ survey identified processes of care for mothers and babies. The role of PHNs in communicating and building relationships with new mothers, and in the provision of health promoting advice and support is clearly evident.
Conclusion and Implications
Results from this study will facilitate the development and subsequent pilot implementation of a QCM to identify practice and measure quality of care provided by PHNs.