Nurses’ Perspectives on the Intersection of Safety and Informed Decision Making in Maternity Care

Abstract

Objective To explore maternity nurses' perceptions of women's informed decision making during labor and birth to better understand how interdisciplinary communication challenges might affect patient safety. Design Constructivist grounded theory. Setting Four hospitals in the Western United States. Participants Forty six (46) nurses and physicians practicing in maternity units. Methods Data collection strategies included individual interviews and participant observation. Data were analyzed using the constant comparative method, dimensional analysis, and situational analysis (Charmaz, 2006; Clarke, 2005; Schatzman, 1991). Results The nurses' central action of holding off harm encompassed three communication strategies: persuading agreement, managing information, and coaching of mothers and physicians. These strategies were executed in a complex, hierarchical context characterized by varied practice patterns and relationships. Nurses' priorities and patient safety goals were sometimes misaligned with those of physicians, resulting in potentially unsafe communication. Conclusions The communication strategies nurses employed resulted in intended and unintended consequences with safety implications for mothers and providers and had the potential to trap women in the middle of interprofessional conflicts and differences of opinion.

Risk management—Evaluation of healthcare professionals' reasoning about and understanding of maternity care

“…The results revealed that conflicts between team members influenced the decision‐making process in a critical situation. These results are congruent with the evidence presented by Lyndon, Zlatnik, and Wachter () and Jacobson, Zlatnik, Powell Kennedy, and Lyndon () that a challenge to effective interprofessional communication included differing professional views on childbirth management leading to conflict. In addition, differences in perceptions of risk can potentially result in miscommunication and increase the probability of inadequate care (Van Otterloo & Connelly, ).…”

Thematic analysis of US stakeholder views on the influence of labour nurses’ care on birth outcomes

“…Jacobson et al 24 observed that some strategies labour nurses used for education and advocacy veered into paternalistic territory and risked creating confusion and emotional suffering for women. One of the conditions under which this occurred was nursing concern for safety, similar to our finding that nurses used their sense of risk to frame constraint of women's options.…”

Healthcare professionals' perceptions of patient safety for the woman in childbirth in Sweden – An interview study

“…Studies of intrapartum care have found that midwives, physicians and nurses all experience safety concerns (Maxfield, Lyndon, Kennedy, O'Keeffe, & Zlatnik, 2013) and patients being put at risk due to a failure to listen to or respond to safety concerns (Lyndon et al, 2014). Furthermore, nurses perceived a risk of harmful interventions and lack of information to the woman giving birth (Jacobson et al, 2013). Another patient safety problem raised in intrapartum care is communication between nurses and physicians (Lyndon et al, 2012).…”

“…Maternal death due to pregnancy and childbirth is unusual and considered a major human tragedy (Nyfløt, Ellingsen, Yli, Øian, & Vangen, ). Research about patient safety in connection to childbirth often targets the neonate (Ashcroft, ; Millde Luthander, ), with fewer studies focusing on the woman giving birth (Jacobson, Zlatnik, Kennedy, & Lyndon, ; Sheldon et al, ).…”