Assessing health worker performance in assisting a mother to learn the skills of hand expression of breast milk

Breastfeeding is important in the health of children and their mothers, and expressed milk is particularly important when the infant is ill or unable to breastfeed. Mothers may not receive effective assistance to learn skills of milk expression. This study was undertaken to examine if a mother-centred framework could be used to develop a method to assess a lactation consultant student’s performance in assisting a mother in learning skills for hand expression. As there was no apparent research on techniques of hand expression, a three-round Delphi exercise was conducted with experts from three continents, in conjunction with a review of educational materials and observation of mothers expressing. This resulted in a composite list of knowledge and skills that a mother needed. A review of educational methods indicated that adult learning and self-efficacy techniques could be used effectively for assisting the mother’s learning. These techniques were in line with expected professional practice of student lactation consultants. The skills of expression were blended with the skills of assisting learning to develop an instrument to facilitate assessment by observation in a real workplace encounter. Gathering the views of the mother, of the student assisting, and of an examiner, facilitates feedback to the student as well as an assessment score. The instrument and assessment process underwent a validation process involving panels composed of students, mothers and examiners and educators. The evidence from this validation indicated that the instrument was representative and relevant to the expected behaviours of assisting the mother, that it was useable by the three groups, and that it was likely to pick up a poorly performing student. The three panels’ views indicated that all items should meet a minimum level to pass, that the views of the mother, the student and the examiner should all have value, and that a visual analogue scale provided an acceptable means to mark the performance. A passing standard was determined that can be used for pilot testing of the instrument and process, and for testing of reliability. The instruments and assessment process are brought to readiness for pilot testing with students to determine their performance as well as the feasibility of multi-source assessment that is mother-centred and values the views of the mother. It potentially provides a means of effectively assessing one area of clinical practice and could be extended to assess other areas.