The role of the nurse in labor and delivery as perceived by nurses and patients

A new way to measure nursing: computer timing of nursing time and support of laboring patients

The goal of this observational, descriptive study was to use an innovative computerized program to measure simultaneous nursing time and support activities during the first stage of active labor. No previous studies have looked at nursing time or support from the view of those in the labor room or have measured multitasking in labor care. A computerized timing program (developed using Microsoft Visual C++ version 6.0) was developed to accommodate time recording of up to seven simultaneous activities for nursing events during labor care. The program was highly usable and effective. It was determined that labor nurses spent an average of 69% of their time out of the patient's rooms and 31% of their time in the room of the active laboring patient. On average, patients received nursing supportive care for 13% of their active phase of labor. While in the room, 41% of the nurses' time was spent in supportive care and 63% was spent in other nursing activities. On average, nurses engage in only one observable activity 70% of the time; two activities, 20% of the time; and three activities, 1.5% of the time. This finding falls short of recommendations for provision of labor support.

From innovation to common practice: perinatal nursing pre-1970 to 2005

The history of perinatal nursing from before 1970 to the present is characterized by innovations that became common practice in later years. These innovations include fetal monitoring, mother/baby care, and early postpartum discharge. The driving forces behind changes in care within the social context of the times were scientific/medical developments and families' desires for the best possible childbearing experience. With innovations becoming commonplace, nursing practice became more complex. How nurses approach present-day challenges of increasing technology of birth, looming threats of litigation, and providing care under time and economic restraints is continuing to evolve.

Women's perceptions of helpful and unhelpful nursing behaviors during labor: a study in Taiwan

BACKGROUND

The job of the nurse in labor and delivery is not only to ensure a safe delivery but also to create a positive and satisfying childbirth experience. Few studies have been conducted of women's perceptions about the ideal image of the obstetric nurse during labor, and most previous studies involved only North American or European women. The purpose of this study was to assess Taiwanese women's perspectives about their encounters with obstetric nurses during labor.

METHODS

Interviews of a convenience sample of 50 mothers experiencing normal childbirth in Taiwan were conducted. The interviews were tape recorded and transcribed, and the transcriptions were analyzed to develop coding categories and identify themes.

RESULTS

Sixty percent of the participants reported having received helpful nursing behaviors only; 38 percent reported having received both helpful and unhelpful nursing behaviors. Helpful labor-coping measures that were valued by participants included performing roles of emotional support providers, comforters, information/advice providers, professional technical skills providers, and advocates. Forty percent of the participants reported that some nurses had hindered their labor-coping ability by failing to provide emotional support, comfort measures, adequate or correct information/advice, or to perform technical duties.

CONCLUSIONS

The ideal nursing image encompasses the roles of emotional supporter, comforter, information/advice provider, professional/technical skill provider, and advocate. The findings may help obstetric team members better understand patients' needs, and enable them to provide better support during labor and to prevent unhelpful nursing behaviors.

Identifying labor support actions of intrapartum nurses

OBJECTIVE

To identify specific nursing actions that best characterize labor support from the nurse's perspective.

DESIGN

A descriptive survey design using a three-round Delphi technique was used to explore the views of intrapartum nurses in the United States related to labor support.

PARTICIPANTS

Five hundred AWHONN members who identified themselves as intrapartum nurses were invited to participate in the survey. One hundred eighty-six nurses agreed to participate. Participants who submitted usable surveys in each round: round one, n = 166; round two, n = 115; and round three, n = 117. Eighty-seven nurses participated in all three rounds of the survey.

RESULTS

The participants identified 55 specific nursing actions as supportive care. These interventions ranged from psychosocial support such as remaining with the mother if she is fearful to physical support measures such as position changes. The nurses clearly distinguished between supportive nursing care and the assessment and technical aspects of their job. The nurses also identified the overall goals of intrapartum nursing were to assure a safe outcome for the newborn (82.8% of participants) and for the mother (75% of participants).

CONCLUSIONS

The supportive actions identified by this panel of intrapartum nurses were similar to ones identified by mothers in other studies. Nurses made a clear distinction between supportive nursing care and assessment skills or technical tasks.

Nursing support during labor

This descriptive study replicates and extends the previous work on nursing support during labor. Within 72 hours of giving birth, 88 participants rated 25 selected nursing behaviors on a Likert scale as to their perceived helpfulness, with two open-ended questions for additional comments on helpful nursing behaviors. Nursing behaviors were categorized as emotional, informational, or tangible support. The majority of behaviors considered most helpful were in the emotional support category. Sixteen of the 25 behaviors were considered helpful, with the most helpful behaviors being making the woman feel cared about as an individual, appearing calm and confident, and treating the woman with respect. Findings were consistent with those of a previous study and suggest that, regardless of the pain management used, nurses supporting childbearing women must not only be competent but also use a high degree of interpersonal skills in providing nursing care.

Women's evaluations of their labor and delivery nurses

OBJECTIVE

To document women's evaluations of their labor and delivery nurses.

DESIGN

An exploratory, qualitative study using open-ended, intensive, tape-recorded interviews.

SETTING

Postpartum unit of a 400-bed midwestern hospital, except for two interviews in the women's homes.

PARTICIPANTS

Sixty-one Lamaze-prepared, married, multigravidae, aged 21-37 years.

RESULTS

Ninety percent of the women evaluated their nurses favorably, 10% unfavorably. Nurses were evaluated favorably because of their positive participation (80%), acceptance (78%), information giving (75%), encouragement (65%), presence (53%), and competence (7%).

CONCLUSIONS

Although technical competence is important, manner, provision of supportive care, and acceptance of each woman as a unique human being may be a nurse's most important characteristics.

Women's choice of childbirth setting

As part of a larger study on women's views of the childbirth experience, this study was focused on women's choice of childbirth setting. Sixty-one Lamaze-prepared, married multigravidae between the ages of 21 and 37 and experiencing a normal pregnancy were interviewed twice: at 36-38 weeks gestation in their homes and during their postpartum stay in the hospital. Data were collected using (a) two semistructured interview guides consisting of open-ended questions about choosing a caregiver and the place of birth and about describing the actual childbirth experience, (b) a self-administered sociodemographic questionnaire, and (c) an obstetrical and infant data form. The tape-recorded interviews were transcribed verbatim. Qualitative data analysis was focused on reasons for choosing a hospital and a physician, reasons for choosing or not choosing a birthing room, and the outcomes of the decisions. An understanding of women's childbirth needs as reflected in their choices can suggest areas where flexibility might be built into maternity care programs.

Women's expectations of the labor and delivery nurse

Sixty-one, Lamaze-prepared, married multigravidae identified their expectations of the labor and delivery nurse in semistructured interviews conducted at 36 to 38 weeks' gestation. Findings indicate variations in the amount of involvement women expected from the nurses during labor and delivery: limited (n = 17), moderate (n = 22), or extensive (n = 22). Women varied in the amount of time they wanted nurses present, who they expected to make caregiving decisions, and whether or not they wanted nurses to assist them in managing labor and delivery.