Validation and modification of a cardiotocograph interpretation training programme for midwives in South Africa to address existing interpretation inconsistencies, using the virtual nominal group technique

Abstract

Background. Conventional models of cardiotocograph (CTG) interpretation training have focused on adherence to interpretation guidelines. There is a need for training in interpreting CTGs that emphasises integrating the complete clinical picture to inform clinical decision-making and improve patient safety. Objectives. To develop and validate a CTG interpretation training programme for midwives in South Africa to address the existing inconsistencies in interpretation. Methods. This study was underpinned by the Analysis, Development, Design, Implementation and Evaluation (ADDIE) theoretical framework. The study followed an explanatory sequential mixed-methods design with the aim of exploring and describing midwives’ level of knowledge of CTG interpretation and their learning needs. The learning needs identified informed the development of a training programme. A panel of nine experts participated in a virtual nominal group technique to validate the training programme and prioritise the learning units through anonymous ranking. Results. CTG interpretation training made up of the following learning units was developed and validated with the assistance of maternal and child health experts: Introduction to CTG interpretation; Technical aspects of CTG monitoring; Factors that affect the fetal heart rate during labour; Diagnosis; Clinician-woman relationship; Effective and timely communication of accurate information; Formulation of a comprehensive management plan after CTG interpretation; Using appropriate guidelines to inform decision-making; and Medicolegal hazards. Conclusion. This CTG interpretation programme differs from other conventional training programmes in that it focuses on the multifaceted nature of CTG interpretation and does not confine the training to CTG interpretation guidelines.