Measuring Nurses' Attitudes and Beliefs about Childbirth

• Objective: Researchers have found that nursing care can influence patient outcomes during childbirth. The attitudes and beliefs of labor and delivery nurses may affect their care decisions and interventions. To conduct further research on nursing care and patient outcomes, a reliable and valid instrument to measure nurse attitudes and beliefs about childbirth is needed.
• Design: The Nurse Attitudes and Beliefs Questionnaire-Revised (NABQ-R) contains 42-items in 5 theoretically derived domains.  Each item is scored with a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree).  A higher score indicates more positive attitudes towards physiologic birth.
  
• Setting: An e-mail invitation containing a link to a secure electronic survey was sent to all Colorado AWHONN members.
• Sample: The response rate was 21.6% with complete surveys returned from 84 labor and delivery nurses with a mean age of 46.7 years and 18.9 years of perinatal nursing experience.  The sample was 98% White with an educational distribution of 17.9% diploma/associate, 42.9% baccalaureate, and 39.3% graduate degrees.
• Methods: This online survey study provided an initial psychometric test of the NABQ-R.
  
• Results: The NABQ-R scores ranged from 82–156 with a mean of 121.99 + 12.77. Cronbach's α internal consistency reliability estimate was .90.  Analysis of variance demonstrated a significant effect of education on NABQ-R scores such that nurses with graduate degrees had significantly more positive attitudes than nurses with baccalaureate (p = .003) or diploma/associate degrees (p = .002). To study construct validity, an exploratory factor analysis (EFA) using principal component analysis and varimax rotation was conducted. Factors with an eigenvalue ≥ 1 were retained and the scree slope suggested a 5-factor solution. Next, a varimax rotation was used with 5 specified factors that accounted for 46.11% of the variance with all items loading on at least one factor. We named the factors:  (1) Women's Experience of Birth; (2) Women's Autonomy; (3) Medical Model Conflict; (4) Breech Safety; and (5) Intervention Influence.
• Conclusion/Implications for nursing practice: We consider this analysis preliminary to a more robust psychometric testing of the NABQ-R with a larger sample. Our results support acceptable initial psychometric properties for the NABQ-R and the EFA results were consistent with existing theory. The development of a theoretically and psychometrically sound instrument to measure nurse attitudes toward physiologic birth will foster additional research to expand our understanding of how nurse attitudes affect the process and outcomes of labor and birth.
  
• Keywords: Nurse attitudes, labor and delivery nurses, childbirth