A theoretical framework for nurse-midwifery practice.

Abstract

The purpose of this research was to test the predicted relationships among a component of nurse-midwifery care, psychosocial health outcomes and other maternal psychosocial variables. The theoretical framework for the research was the Intrapartum Care Level of the Nurse-Midwifery Practice Model, a middle range theory. Previous nurse-midwifery research had been based on theories and models not specific to nurse-midwifery practice. A nonexperimental, correlational design was used, with measures in the last trimester of pregnancy and the first month following birth. The psychosocial variables measured were prenatal care satisfaction, personable environment, positive presence, labor support, transcendence, labor satisfaction and enhanced self-concept. Purposive sampling was used at a birth center in a Southwestern city where women received nurse-midwifery care for pregnancy, labor and birth. The sample of 89 women consisted of 35 primiparas and 54 multiparas, with a mean age of 29 years; 46.1% gave birth at the birth center and 53.9% gave birth at a local hospital. The primary instruments for the research included the Prenatal Satisfaction Questionnaire, the Attitude Toward Issues in Choice of Childbirth Scale, the Positive Presence Index, the Labor and Birth Support Inventory, the Coping in Labor and Delivery Scale, the Labor and Delivery Satisfaction Questionnaire, and the Self-Confidence Scale of the Adjective Check List. The secondary instruments, used for the evaluation of construct validity, included the Positive Presence Index - Alternate Format, the Labor and Birth Coping Index, the Labor and Birth Satisfaction Index, and the Self-Concept Index - Alternate Format. Acceptable levels of reliability and validity were obtained for the instruments. The predicted relationships from the Model were tested with causal analysis using multiple regression and residual analysis. The empirical rather than the theoretical model was supported by the data. Prenatal care satisfaction, personable environment, positive presence and transcendence explained 66% of the variance in labor satisfaction, with an additional 2% explained variance with the addition of the situational variable of consultation. Positive presence had the greatest direct effect (B =.70) and also explained 5% of the variance in enhanced self-concept. The empirically significant relationships were clinically relevant.