A Capacity-Building, Multisite, Quality Improvement Project Aimed at Respectful Maternity Care

To evaluate the impact of an evidence-based respectful maternity care program on registered nurses' attitudes and beliefs about childbirth practices across multiple U.S. hospital maternity and neonatal units. Secondary objectives included assessing maternal perceptions of care and identifying facilitators and barriers to program adoption.

A Plan-Do-Study-Act framework with a one-group pretest-posttest design with a qualitative strand to investigate changes in nurses' attitudes and beliefs.

Nine maternity and neonatal in-patient care units located across the United States.

Registered nurses working in maternity and neonatal care units were recruited using purposive sampling. A patient survey was concurrently conducted for deeper insight.

Units implemented the Association of Women's Health, Obstetric and Neonatal Nurses Respectful Maternity Care Framework and Evidence-Based Clinical Practice Guideline as an intervention. Quantitative and qualitative data captured the effect of the intervention. Nurses completed the 42-item Nurse Attitudes and Beliefs Questionnaire-Revised (n = 99). Focus groups of site coordinators (N = 9) were conducted to identify barriers to and facilitators of program implementation. To provide a deeper level of understanding, patients answered the Women's Perspectives on Respectful Maternity Care questionnaire (preintervention n = 57, postintervention n = 34).

A paired-samples t test showed a significant increase in nurses' attitude and belief scores from preintervention to postintervention (t[98] = -2.69, p = .008), with a moderate correlation between paired observations (r = 0.68). Focus group analysis highlighted barriers such as institutional constraints, hierarchies, and lack of protected training time, whereas peer support, autonomy, and commitment to humanized care facilitated implementation. There was no significant difference in patient perspectives.

Findings suggest that positive attitude and belief shifts are supported by local culture, interdisciplinary alignment, and opportunities for reflection. An evidence-based respectful maternity care program is associated with an improvement in nurses' attitudes and beliefs toward physiologic childbirth.