Development of an instrument to measure mothers' perceptions of professional labor support

Abstract

The purpose of this methodological study was to estimate the psychometric properties ofthe Perceived Professional Labor Support Tool (PPLST), a 51-item instrument designed to measure mothers' perceptions of professional labor support (PLS) provided by the registered nurse during labor. The PPLST was based upon a new conceptual model of PLS called the "5 Cs": caring, communication, comfort, competency, and concern. The sample (n = 256) consisted of mothers with non-complicated pregnancies who delivered healthy term infants by either vaginal delivery (91.1 %) or cesarean section ( 8.1 %), at five different birth centers. Mothers were: (a) less than 48 hours postpartum, (b) age 18-42 years (M = 26.1), (c) gravida (M = 2.3), (d) para (M = 1.9). Ethnic representation included: African American (9.9%), Caucasian (78.3%), Hispanic (6. 7%), Native American (1.6%), Asian (1.6%), and other (2%). Psychometric properties of the initial 51-item PPLST that were estimated included: content validity (CVI =1.0), internal consistency (a= .91), test-retest stability!= .93, Q = .00, and concurrent validity with 6 questions representing the 5 Cs conceptual model of PLS, L ==.44 , 12 = .01 . Item reduction using a combination ofCronbach's alpha and principal components analysis (PCA) with varimax rotation resulted in a 30-item scale, the PPLST30, that was internally consistent, a =.94. Six subscales emerged: caring, nurse 's informal communication, nurse's technical communication, monitoringcompetence, professional comfort, and choices- concern. There were significant differences in PPLST30 scores based upon delivery type and ethnicity. Cesarean delivered mothers had lower perceptions ofPLS than those who delivered vaginally. Hispanics and other combined non-Caucasian ethnic groups had lower perceptions of PLS than Caucasians. PLS may not meet multi-cultural needs. The most supportive nursing actions were: (a) being friendly, kind, and respectful; (b) pain management; and (c) monitoring the fetus and mother. Traditional comfort measures (e.g. back rub, hand holding) were considered as least supportive. Findings supported the initial validity and reliability ofthe PPLST30 as a measure ofPLS as well as the "5Cs" conceptual model. The PPLST30, which needs further replication with other samples, could be useful in future outcome studies.